第十九条保健所長は、身体に障害のある児童につき、診査を行ない、又は相談に応じ、必要な療育の指導を行なわなければならない。

Article 19(1)A public health center's director must carry out medical examinations or provide consultation for children with physical disabilities, and must guide medical treatment and education necessary for them.

２保健所長は、疾病により長期にわたり療養を必要とする児童につき、診査を行い、又は相談に応じ、必要な療育の指導を行うことができる。

(2)A public health center's director may carry out medical examinations or provide consultation for children in need of long-term medical treatment due to illness, and may provide guidance for medical treatment and education necessary for them.

３保健所長は、身体障害者福祉法（昭和二十四年法律第二百八十三号）第十五条第四項の規定により身体障害者手帳の交付を受けた児童（身体に障害のある十五歳未満の児童については、身体障害者手帳の交付を受けたその保護者とする。以下同じ。）につき、同法第十六条第二項第一号又は第二号に掲げる事由があると認めるときは、その旨を都道府県知事に報告しなければならない。

(3)When a public health center's director finds that a child to whom a physically disabled certificate is issued pursuant to the provisions of Article 15, paragraph (4) of the Act on Welfare of Persons with Physical Disabilities (Act No. 283 of 1949) (or the custodian of a child to whom a physically disabled certificate is issued as aforementioned, if the person is a child with physical disabilities under 15 years of age; the same applies hereinafter) falls under any of the reasons listed in Article 16, paragraph (2), item (i) or (ii) the same Act, the public health center's director must notify the prefectural governor to that effect.

第二十条都道府県は、結核にかかつている児童に対し、療養に併せて学習の援助を行うため、これを病院に入院させて療育の給付を行うことができる。

Article 20(1)The prefectural government may hospitalize a child suffering from bone and joint tuberculosis or other tuberculosis and provide medical treatment and education benefits to them, in order to afford learning assistance together with medical treatment.

２療育の給付は、医療並びに学習及び療養生活に必要な物品の支給とする。

(2)Medical treatment and education benefits means the provision of medical care and goods necessary for learning and for life with medical treatment.

３前項の医療は、次に掲げる給付とする。

(3)The medical care set forth in the preceding paragraph means the performance listed in the following items:

４第二項の医療に係る療育の給付は、都道府県知事が次項の規定により指定する病院（以下「指定療育機関」という。）に委託して行うものとする。

(4)Medical treatment and education benefits pertaining to the medical care set forth in paragraph (2) are entrusted to, and provided by, a hospital designated by the Minister of Health, Labor and Welfare or the prefectural governor pursuant to the provisions of the following paragraph (hereinafter referred to as a "designated treatment and education institution").

５都道府県知事は、病院の開設者の同意を得て、第二項の医療を担当させる機関を指定する。

(5)The prefectural governor is to designate the medical providers in charge of the medical care set forth in paragraph (2) with the content of organizers of hospitals.

６前項の指定は、政令で定める基準に適合する病院について行うものとする。

(6)The designation set forth in the preceding paragraph is made toward hospitals conforming to the standards specified by a Cabinet Order.

７指定療育機関は、三十日以上の予告期間を設けて、その指定を辞退することができる。

(7)A designated treatment and education institution may decline the designation by giving not less than 30 days of advanced notice.

８都道府県知事は、指定療育機関が第六項の規定に基づく政令で定める基準に適合しなくなつたとき、次条の規定に違反したとき、その他指定療育機関に第二項の医療を担当させるについて著しく不適当であると認められる理由があるときは、その指定を取り消すことができる。

(8)When a designated treatment and education institution ceases to conform to the standards specified by a Cabinet Order pursuant to paragraph (6), violates the provisions of the following Article, or is found to be extremely inappropriate as a designated treatment and education institution in charge of the medical care set forth in paragraph (2) due to any other reason, the prefectural governor may rescind its designation.

第二十一条指定療育機関は、厚生労働大臣の定めるところにより、前条第二項の医療を担当しなければならない。

Article 21A designated treatment and education institution must take charge of the medical care set forth in paragraph (2) of the preceding Article pursuant to the provisions specified by the Minister of Health, Labor and Welfare

第二十一条の二第十九条の十二及び第十九条の二十の規定は、指定療育機関について準用する。この場合において、必要な技術的読替えは、政令で定める。

Article 21-2Provisions of Article 19-12 and Article 19-20 apply mutatis mutandis to a designated treatment and education institution.In this case, necessary terminological replacements is prescribed by Cabinet Order.

第二十一条の三都道府県知事は、指定療育機関の診療報酬の請求が適正であるかどうかを調査するため必要があると認めるときは、指定療育機関の管理者に対して必要な報告を求め、又は当該職員をして、指定療育機関について、その管理者の同意を得て、実地に診療録、帳簿書類その他の物件を検査させることができる。

Article 21-3(1)The prefectural governor, if it is found to be necessary to investigate whether medical fees are correctly claimed by a designated treatment and education institution, may request the manager of the designated treatment and education institution to make a necessary report, or may make relevant official carry out on-site inspection on medical records, books and documents, and other objects of the designated treatment and education institution with the consent of its manager.

２指定療育機関の管理者が、正当な理由がなく、前項の報告の求めに応ぜず、若しくは虚偽の報告をし、又は同項の同意を拒んだときは、都道府県知事は、当該指定療育機関に対する都道府県の診療報酬の支払を一時差し止めることを指示し、又は差し止めることができる。

(2)If the manager of a designated treatment and education institution, without justifiable ground, fails to respond to the request for reporting set forth in the preceding paragraph or makes a false report, or refuses the consent set forth in the same paragraph, the prefectural governor may instruct temporary halt of, or halt of, the payments of medical fees by the prefectural government to the relevant designated treatment and education institution.

３厚生労働大臣は、前項に規定する都道府県知事の権限に属する事務について、児童の利益を保護する緊急の必要があると認めるときは、都道府県知事に対し同項の事務を行うことを指示することができる。

(3)The Minister of Health, Labor and Welfare, if it is found to be an urgent necessity to protect interests of a child with regard to the affairs placed under the authority of a prefectural governor prescribed in the preceding paragraph, may instruct the prefectural governor to conduct the affairs set forth in the same paragraph.

第二十一条の四国は、小児慢性特定疾病の治療方法その他小児慢性特定疾病その他の疾病にかかつていることにより長期にわたり療養を必要とする児童等（第三項及び次条において「疾病児童等」という。）の健全な育成に資する調査及び研究を推進するものとする。

Article 21-4(1)The national government is to promote surveys and research contributing to the treatment method of specified chronic pediatric diseases and the sound upbringing of children, etc. who require long-term treatment due to other specified chronic pediatric diseases or other diseases (referring to as "children, etc. with diseases" in paragraph (3) and the following Article).

２国は、前項に規定する調査及び研究の推進に当たつては、難病（難病の患者に対する医療等に関する法律第一条に規定する難病をいう。以下この項において同じ。）の患者に対する良質かつ適切な医療の確保を図るための基盤となる難病の発病の機構、診断及び治療方法に関する調査及び研究との適切な連携を図るよう留意するものとする。

(2)When the national government promotes surveys and research provided in the preceding paragraph, the national government is to pay attention to appropriate coordination on surveys and research on the mechanism of the occurrence, diagnosis and the treatment method of intractable diseases which serve as foundation for securing high-quality and appropriate medical care for patients with intractable diseases (which refers to the intractable diseases provided in Article 1 of Act on Medical Care for Patients with Intractable Diseases; the same applies hereinafter in this paragraph).

３厚生労働大臣は、第一項に規定する調査及び研究の成果を適切な方法により小児慢性特定疾病の治療方法その他疾病児童等の健全な育成に資する調査及び研究を行う者、医師、疾病児童等及びその家族その他の関係者に対して積極的に提供するものとする。

(3)The Minister of Health, Labour and Welfare is to actively provide results of the surveys and research provided in paragraph (1) to persons who conduct surveys and research contributing to the treatment method of specified chronic pediatric diseases and the sound upbringing of children, etc. with diseases, physicians, children, etc. with diseases, their families, and other relevant persons by appropriate means.

４厚生労働大臣は、前項の規定により第一項に規定する調査及び研究の成果を提供するに当たつては、個人情報の保護に留意しなければならない。

(4)When the Minister of Health, Labour and Welfare offers the results of the surveys and research provided in paragraph (1) pursuant to the provisions of the preceding paragraph, the Minister of Health, Labour and Welfare must pay attention to protecting personal information.

第二十一条の五厚生労働大臣は、良質かつ適切な小児慢性特定疾病医療支援の実施その他の疾病児童等の健全な育成に係る施策の推進を図るための基本的な方針を定めるものとする。

Article 21-5Ministry of Health, Labour and Welfare is to formulate the basic policy to promote measures pertaining to implementing high-quality and appropriate medical support for specified chronic pediatric diseases and sound upbringing of other children, etc. with diseases.

第二十一条の五の二障害児通所給付費及び特例障害児通所給付費の支給は、次に掲げる障害児通所支援に関して次条及び第二十一条の五の四の規定により支給する給付とする。

Article 21-5-2The payment of outpatient benefits for children with disabilities and exceptional case outpatient benefits for children with disabilities are the benefits provided pursuant to the following Article and Article 21-5-4 concerning outpatient support for children with disabilities listed as follows.

第二十一条の五の三市町村は、通所給付決定保護者が、第二十一条の五の七第八項に規定する通所給付決定の有効期間内において、都道府県知事が指定する障害児通所支援事業を行う者（以下「指定障害児通所支援事業者」という。）又は指定発達支援医療機関（以下「指定障害児通所支援事業者等」と総称する。）から障害児通所支援（以下「指定通所支援」という。）を受けたときは、当該通所給付決定保護者に対し、当該指定通所支援（同条第七項に規定する支給量の範囲内のものに限る。以下この条及び次条において同じ。）に要した費用（食事の提供に要する費用その他の日常生活に要する費用のうち厚生労働省令で定める費用（以下「通所特定費用」という。）を除く。）について、障害児通所給付費を支給する。

Article 21-5-3(1)A municipality, if a recognized outpatient beneficiary custodian receives outpatient support for children with disabilities (hereinafter referred to as "designated outpatient support") from a person who provides outpatient support services for children with disabilities designated by a prefecture (hereinafter referred to as "designated operator of outpatient support services for children with disabilities") or designated developmental support medical institution (hereinafter referred to as "designated operator of outpatient support services, etc. for children with disabilities" collectively) within the effective period of grant decision on outpatient benefits payment set forth in Article 5-7, paragraph (8), is to pay outpatient benefits for children with disabilities with regard to the expenses required for the relevant designated outpatient support (excluding the expenses specified by Order of the Ministry of Health, Labour and Welfare from the expenses required for provision of meals and other expenses for daily life (hereinafter referred to as "outpatient specified expenses)) to the relevant recognized outpatient beneficiary custodian.

２障害児通所給付費の額は、一月につき、第一号に掲げる額から第二号に掲げる額を控除して得た額とする。

(2)The amount of payment of outpatient benefits for children with disabilities is the amount obtained by deducting the amount listed in item (i) from the one listed in item (ii).

第二十一条の五の四市町村は、次に掲げる場合において、必要があると認めるときは、厚生労働省令で定めるところにより、当該指定通所支援又は第二号に規定する基準該当通所支援（第二十一条の五の七第七項に規定する支給量の範囲内のものに限る。）に要した費用（通所特定費用を除く。）について、特例障害児通所給付費を支給することができる。

Article 21-5-4(1)A municipality may pay exceptional case outpatient benefits for children with disabilities for the expenses required for the expenses (excluding outpatient specified expenses) the relevant designated outpatient support or appropriate outpatient support prescribed in item (ii) (limited within amount of grant specified in Article 21-5-7, paragraph (7)) pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare in the following cases if acknowledged to be necessary.

２都道府県が前項第二号の条例を定めるに当たつては、第一号から第三号までに掲げる事項については厚生労働省令で定める基準に従い定めるものとし、第四号に掲げる事項については厚生労働省令で定める基準を標準として定めるものとし、その他の事項については厚生労働省令で定める基準を参酌するものとする。

(2)The provisions of item (ii) of the preceding paragraph is specified in accordance with the standards specified by Order of Ministry of Health, Labour and Welfare concerning the particulars listed in items (i) through (iii); the particulars of item (iv) is specified by setting based on the standard provided in Order of the Ministry of Health, Labour and Welfare and other particulars are specified by taking into consideration the standard provided in Order of the Ministry of Health, Labour and Welfare.

３特例障害児通所給付費の額は、一月につき、同一の月に受けた次の各号に掲げる障害児通所支援の区分に応じ、当該各号に定める額を合計した額から、それぞれ当該通所給付決定保護者の家計の負担能力その他の事情をしん酌して政令で定める額（当該政令で定める額が当該合計した額の百分の十に相当する額を超えるときは、当該相当する額）を控除して得た額を基準として、市町村が定める。

(3)A municipality is to determine the amount of exceptional case outpatient benefits for specified children with disabilities based on the amount obtained by per month by deducting the amount provided by Cabinet order by taking into account the financial capacity of the household of the relevant recognized outpatient beneficiary custodian respectively (when ten-hundredths (10/100) of the relevant amount provided by the relevant Cabinet Order exceeds the amount provided by a Cabinet Order, the relevant amount equivalent thereto) from the total sum of the amount provided by the following items according to the category of outpatient support for children with disabilities listed in the relevant items in the same month.

第二十一条の五の五障害児通所給付費又は特例障害児通所給付費（以下この款において「障害児通所給付費等」という。）の支給を受けようとする障害児の保護者は、市町村の障害児通所給付費等を支給する旨の決定（以下「通所給付決定」という。）を受けなければならない。

Article 21-5-5(1)A custodian of a child with disabilities who intend to receive payment of outpatient benefits for children with disabilities or exceptional case outpatient benefits for children with disabilities (referring to as "outpatient benefits, etc. for children with disabilities" hereinafter in this subsection) must receive decision for payment of municipal outpatient benefits, etc. for children with disabilities (hereinafter referred to as "grant decision on outpatient benefits ").

２通所給付決定は、障害児の保護者の居住地の市町村が行うものとする。ただし、障害児の保護者が居住地を有しないとき、又は明らかでないときは、その障害児の保護者の現在地の市町村が行うものとする。

(2)Grant decision on outpatient benefits is made by the municipality where the custodian of a child with disabilities has their residences; provided, however, that the custodian of the child with disabilities do not have their residence or whose residence is not obvious, another municipality where such custodian of the child with disabilities has their current residences are to make such grant decision.

第二十一条の五の六通所給付決定を受けようとする障害児の保護者は、厚生労働省令で定めるところにより、市町村に申請しなければならない。

Article 21-5-6(1)When the custodian of a child with disabilities intends to receive grant decision on outpatient benefits, the custodian is to make an application to the municipality pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

２市町村は、前項の申請があつたときは、次条第一項に規定する通所支給要否決定を行うため、厚生労働省令で定めるところにより、当該職員をして、当該申請に係る障害児又は障害児の保護者に面接をさせ、その心身の状況、その置かれている環境その他厚生労働省令で定める事項について調査をさせるものとする。この場合において、市町村は、当該調査を障害者の日常生活及び社会生活を総合的に支援するための法律第五十一条の十四第一項に規定する指定一般相談支援事業者その他の厚生労働省令で定める者（以下この条において「指定障害児相談支援事業者等」という。）に委託することができる。

(2)If the application of the preceding paragraph has been filed, a municipality, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, is to make the relevant official interview with the child with disabilities or the custodian of the child with disabilities pertaining to relevant application and inspect their physical and mental status, circumstances where they are placed, and other particulars prescribed in Order of the Ministry of Health, Labour and Welfare.In this case the municipality may entrust the relevant investigation to designated operators of general consultation support business prescribed in Article 51-14, paragraph (1) of Act on the Comprehensive Support for the Daily and Life in Society of Persons with Disabilities and other persons specified by Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "designated operators, etc. of consultation support services for children with disabilities" in this Article).

３前項後段の規定により委託を受けた指定障害児相談支援事業者等は、障害児の保健又は福祉に関する専門的知識及び技術を有するものとして厚生労働省令で定める者に当該委託に係る調査を行わせるものとする。

(3)The designated operators, etc. of consultation support services for children with disabilities who are entrusted pursuant to the provisions of the second sentence of the preceding paragraph are to make the persons specified by Order of the Ministry of Health, Labour and Welfare as having specified knowledge and skills relating to health or welfare for children with disabilities conduct the investigation pertaining to the relevant entrustment.

４第二項後段の規定により委託を受けた指定障害児相談支援事業者等の役員（業務を執行する社員、取締役、執行役又はこれらに準ずる者をいい、相談役、顧問その他いかなる名称を有する者であるかを問わず、法人に対し業務を執行する社員、取締役、執行役又はこれらに準ずる者と同等以上の支配力を有するものと認められる者を含む。次項並びに第二十一条の五の十五第三項第六号（第二十四条の九第三項（第二十四条の十第四項において準用する場合を含む。）及び第二十四条の二十八第二項（第二十四条の二十九第四項において準用する場合を含む。）において準用する場合を含む。）、第二十四条の十七第十一号及び第二十四条の三十六第十一号において同じ。）若しくは前項の厚生労働省令で定める者又はこれらの職にあつた者は、正当な理由なしに、当該委託業務に関して知り得た個人の秘密を漏らしてはならない。

(4)The officers of the designated operators, etc. of consultation support services entrusted pursuant to the provisions of the second sentence of paragraph (2) (meaning employees, directors, or executive officers who execute business, or the equivalent thereof, including those recognized as having the same or greater influence over corporations as employees who execute business, directors, corporate officers, or the equivalent thereof, regardless of what titles they may have, such as counselor, consultant, etc., which includes the cases of applying mutatis mutandis in the following paragraph and Article 21-5-15, paragraph (3), item (vi) including the case of applying mutatis mutandis in Article 24-9, paragraph (3) (including the case of applying mutatis mutandis in Article 24-10, paragraph (4)) and Article 24-28, paragraph (2) (including the case of applying mutatis mutandis in Article 24-29, paragraph (4))), or the persons prescribed in Order of the Ministry of Health, Labour and Welfare set forth in the preceding paragraph or the persons who used to be in such positions must not disclose personal secrets obtained concerning the relevant entrusted services without a valid reason.

５第二項後段の規定により委託を受けた指定障害児相談支援事業者等の役員又は第三項の厚生労働省令で定める者で、当該委託業務に従事するものは、刑法その他の罰則の適用については、法令により公務に従事する職員とみなす。

(5)With regard to application of the Penal Code and other penal provisions, an officer or employee of a designated operators, etc. of consultation support services for children with disabilities who are entrusted pursuant to the provisions of the second sentence of paragraph (2) is deemed to be an official engaged in the public services pursuant to laws and regulations.

第二十一条の五の七市町村は、前条第一項の申請が行われたときは、当該申請に係る障害児の心身の状態、当該障害児の介護を行う者の状況、当該障害児及びその保護者の障害児通所支援の利用に関する意向その他の厚生労働省令で定める事項を勘案して障害児通所給付費等の支給の要否の決定（以下この条において「通所支給要否決定」という。）を行うものとする。

Article 21-5-7(1)If the application of paragraph (1) of the preceding Article is filed, a municipality is to decide the necessity of grant of payment of outpatient benefits, etc. for children with disabilities (hereinafter referred to as "decision on grant necessity" in this Article) by taking into consideration the mental and physical condition of the child with disabilities pertaining to the relevant application, the condition of the person who takes care of the relevant child with disabilities, the intention relating to use of outpatient support for children with disabilities of the relevant child with disabilities and their custodian and other particulars prescribed in Order of the Ministry of Health, Labour and Welfare.

２市町村は、通所支給要否決定を行うに当たつて必要があると認めるときは、児童相談所その他厚生労働省令で定める機関（次項、第二十一条の五の十及び第二十一条の五の十三第三項において「児童相談所等」という。）の意見を聴くことができる。

(2)If a municipality acknowledges it is necessary to make decision on grant necessity, it may hear the opinions of child guidance center and other organizations specified by Order of the Ministry of Health, Labour and Welfare (referring to as "child guidance center, etc." in the following paragraph, Article 21-5-10 and Article 21-5-13, paragraph (3)).

３児童相談所等は、前項の意見を述べるに当たつて必要があると認めるときは、当該通所支給要否決定に係る障害児、その保護者及び家族、医師その他の関係者の意見を聴くことができる。

(3)If a child guidance center, etc. acknowledges it is necessary to express the opinions of the preceding paragraph, it may hear the opinions of a child with disabilities, their custodian and family, physician and other relevant persons pertaining to the relevant decision on grant necessity for outpatient benefits.

４市町村は、通所支給要否決定を行うに当たつて必要と認められる場合として厚生労働省令で定める場合には、厚生労働省令で定めるところにより、前条第一項の申請に係る障害児の保護者に対し、第二十四条の二十六第一項第一号に規定する指定障害児相談支援事業者が作成する障害児支援利用計画案の提出を求めるものとする。

(4)A municipality, if Order of the Ministry of Health, Labour and Welfare specifies it as necessary to make decision on grant necessity, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, is to request the custodian of the child with disabilities pertaining to the application of paragraph (1) of the preceding Article to submit a proposed plan for utilization of support for children with disabilities which designated operators of consultation support services for children with disabilities prepare prescribed in Article 24-26, paragraph (1), item (i).

５前項の規定により障害児支援利用計画案の提出を求められた障害児の保護者は、厚生労働省令で定める場合には、同項の障害児支援利用計画案に代えて厚生労働省令で定める障害児支援利用計画案を提出することができる。

(5)The custodian of the child with disabilities who is requested to submit proposed support use plan for children with disabilities may submit the proposed support use plan for children with disabilities specified in Order of the Ministry of Health, Labour and Welfare in lieu of the one in the same paragraph, in the case where Order of the Ministry of Health, Labour and Welfare specifies.

６市町村は、前二項の障害児支援利用計画案の提出があつた場合には、第一項の厚生労働省令で定める事項及び当該障害児支援利用計画案を勘案して通所支給要否決定を行うものとする。

(6)If the proposed plan for utilization of support for children with disabilities Children with disabilities in the preceding two paragraphs is submitted, a municipality is to make a decision on grant necessity for outpatient benefits by taking into consideration the particulars specified by Order of the Ministry of Health, Labour and Welfare of paragraph (1) and the relevant proposed plan for utilization of support for children with disabilities.

７市町村は、通所給付決定を行う場合には、障害児通所支援の種類ごとに月を単位として厚生労働省令で定める期間において障害児通所給付費等を支給する障害児通所支援の量（以下「支給量」という。）を定めなければならない。

(7)If the grant decision on outpatient benefits payment is made, a municipality must determine the amount of grant of outpatient support for children with disabilities (hereinafter referred to as "amount of grant") to pay outpatient benefits, etc. for children with disabilities in the period specified by Order of the Ministry of Health, Labour and Welfare for each type of outpatient support for children with disabilities by the month.

８通所給付決定は、厚生労働省令で定める期間（以下「通所給付決定の有効期間」という。）内に限り、その効力を有する。

(8)Grant decision on outpatient benefits payment is effective limited to the period specified by Order of Ministry of Health, Labour and Welfare (hereinafter referred to as "effective period for grant decision on outpatient benefits payment")

９市町村は、通所給付決定をしたときは、当該通所給付決定保護者に対し、厚生労働省令で定めるところにより、支給量、通所給付決定の有効期間その他の厚生労働省令で定める事項を記載した通所受給者証（以下「通所受給者証」という。）を交付しなければならない。

(9)If grant decision on outpatient benefits payment is made, a municipality must issue outpatient beneficiary certificate which describes amount of grant, effective period for grant decision on outpatient benefits payment and other particulars specified by Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "outpatient beneficiary certificate") to the relevant recognized outpatient beneficiary custodian pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

１０指定通所支援を受けようとする通所給付決定保護者は、厚生労働省令で定めるところにより、指定障害児通所支援事業者等に通所受給者証を提示して当該指定通所支援を受けるものとする。ただし、緊急の場合その他やむを得ない事由のある場合については、この限りでない。

(10)A recognized outpatient beneficiary custodian who intends to receive designated outpatient support is to receive relevant designated outpatient support by presenting their outpatient beneficiary certificate to the designated operators, etc. of outpatient support services for children with disabilities pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare; provided, however, that this does not apply in the case of an emergency or any other unavoidable reason.

１１通所給付決定保護者が指定障害児通所支援事業者等から指定通所支援を受けたとき（当該通所給付決定保護者が当該指定障害児通所支援事業者等に通所受給者証を提示したときに限る。）は、市町村は、当該通所給付決定保護者が当該指定障害児通所支援事業者等に支払うべき当該指定通所支援に要した費用（通所特定費用を除く。）について、障害児通所給付費として当該通所給付決定保護者に支給すべき額の限度において、当該通所給付決定保護者に代わり、当該指定障害児通所支援事業者等に支払うことができる。

(11)If a recognized outpatient beneficiary custodian has received designated outpatient support from designated operators, etc. of outpatient support services for children with disabilities (limited to the cases where relevant recognized outpatient beneficiary custodian has presented their outpatient beneficiary certificate to relevant designated operators, etc. of outpatient support services for children with disabilities), a municipality may, in lieu of relevant recognized outpatient beneficiary custodian, pay the expenses (excluding outpatient specified expenses) incurred for relevant designated operators, etc. of outpatient support services for children with disabilities payable by relevant recognized outpatient beneficiary custodian to relevant designated operators, etc. of outpatient support services for children with disabilities within the extent of the amount payable to the relevant recognized outpatient beneficiary custodian as outpatient benefits for children with disabilities.

１２前項の規定による支払があつたときは、当該通所給付決定保護者に対し障害児通所給付費の支給があつたものとみなす。

(12)When a payment is made pursuant to the provisions of the preceding paragraph, outpatient benefits for children with disabilities is deemed to have been paid to the relevant recognized outpatient beneficiary custodian.

１３市町村は、指定障害児通所支援事業者等から障害児通所給付費の請求があつたときは、第二十一条の五の三第二項第一号の厚生労働大臣が定める基準及び第二十一条の五の十九第二項の指定通所支援の事業の設備及び運営に関する基準（指定通所支援の取扱いに関する部分に限る。）に照らして審査の上、支払うものとする。

(13)If outpatient benefits for children with disabilities are claimed by designated operators, etc. of outpatient support services for children with disabilities for children with disabilities, a municipality is to pay such benefits after examination in light of the standard specified by Minister of Health, Labour and Welfare of Article 21-5-3, paragraph (2), item (i) and the standards relating to the equipment and operation of the services for designated outpatient support of Article 21-5-19, paragraph (2) (limited to the part relating to handling of designated outpatient support).

１４市町村は、前項の規定による審査及び支払に関する事務を連合会に委託することができる。

(14)The municipality may entrust the duties pertaining to the examination and payment under the preceding paragraph to a federation.

第二十一条の五の八通所給付決定保護者は、現に受けている通所給付決定に係る障害児通所支援の支給量その他の厚生労働省令で定める事項を変更する必要があるときは、厚生労働省令で定めるところにより、市町村に対し、当該通所給付決定の変更の申請をすることができる。

Article 21-5-8(1)A recognized outpatient beneficiary custodian, when requiring for alternation for the amount of grant actually received and other particulars prescribed by Order of the Ministry of Health, Labour and Welfare pertaining to grant decision on outpatient support for children with disabilities, may make an application for alternation for the relevant grant decision on outpatient support for children with disabilities.

２市町村は、前項の申請又は職権により、前条第一項の厚生労働省令で定める事項を勘案し、通所給付決定保護者につき、必要があると認めるときは、通所給付決定の変更の決定を行うことができる。この場合において、市町村は、当該決定に係る通所給付決定保護者に対し通所受給者証の提出を求めるものとする。

(2)A municipality, if it is found to be necessary, may make a decision on alternation of a grant decision on outpatient benefits for a recognized outpatient beneficiary custodian upon receiving an application referred to in the preceding paragraph or authority by taking into consideration the particulars prescribed by Order of the Ministry of Health, Labour and Welfare.In this case, the municipality is to request the relevant recognized outpatient beneficiary custodian to submit their outpatient beneficiary certificate.

３第二十一条の五の五第二項、第二十一条の五の六（第一項を除く。）及び前条（第一項を除く。）の規定は、前項の通所給付決定の変更の決定について準用する。この場合において、必要な技術的読替えは、政令で定める。

(3)The provisions of Article 21-5-5, paragraph (2), Article 21-5-6 (excluding paragraph (1)) and the preceding Article (excluding paragraph (1)) apply mutatis mutandis to the alternation of grant decision on outpatient benefits payment in the preceding paragraph.In this case, necessary terminological replacements are prescribed by Cabinet Order.

４市町村は、第二項の通所給付決定の変更の決定を行つた場合には、通所受給者証に当該決定に係る事項を記載し、これを返還するものとする。

(4)If a decision is made on alternation of a grant decision on outpatient benefits payment of paragraph (2), a municipality is to state the particulars pertaining to the relevant decision on outpatient beneficiary certificate and return it.

第二十一条の五の九通所給付決定を行つた市町村は、次に掲げる場合には、当該通所給付決定を取り消すことができる。

Article 21-5-9(1)A municipality which has made a grant decision on outpatient benefits may rescind the relevant grant decision on outpatient benefits payment in any of the cases listed in the following items:

２前項の規定により通所給付決定の取消しを行つた市町村は、厚生労働省令で定めるところにより、当該取消しに係る通所給付決定保護者に対し通所受給者証の返還を求めるものとする。

(2)A municipality that has rescinded a grant decision on outpatient benefits payment pursuant to the provisions of the preceding paragraph is to ask the recognized outpatient beneficiary custodian pertaining to the rescission to return the outpatient beneficiary certificate pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

第二十一条の五の十都道府県は、市町村の求めに応じ、市町村が行う第二十一条の五の五から前条までの規定による業務に関し、その設置する児童相談所等による技術的事項についての協力その他市町村に対する必要な援助を行うものとする。

Article 21-5-10A prefecture is to provide cooperation on technical particulars conducted by child guidance centers prescribed in Order of the Ministry of Health, Labour and Welfare and other necessary assistance for municipalities in response to requests from the municipality concerning the service conducted by municipalities pursuant to provisions of Article 21-5-5 through the preceding Article.

第二十一条の五の十一市町村が、災害その他の厚生労働省令で定める特別の事情があることにより、障害児通所支援に要する費用を負担することが困難であると認めた通所給付決定保護者が受ける障害児通所給付費の支給について第二十一条の五の三第二項の規定を適用する場合においては、同項第二号中「額）」とあるのは、「額）の範囲内において市町村が定める額」とする。

Article 21-5-11(1)If a municipality applies the provisions of Article 21-5, paragraph (2) to payment of outpatient benefits for children with disabilities received by a recognized outpatient beneficiary custodian since it finds difficult for them to bear expenses spent for outpatient support for children with disabilities due to a disaster or other special circumstances specified by an Order of the Ministry of Health, Labour and Welfare, the term "amount" referred to in item (ii) of the same paragraph is replaced with "the amount specified by the municipality within the range of the amount ".

２前項に規定する通所給付決定保護者が受ける特例障害児通所給付費の支給について第二十一条の五の四第三項の規定を適用する場合においては、同項中「を控除して得た額を基準として、市町村が定める」とあるのは、「の範囲内において市町村が定める額を控除して得た額とする」とする。

(2)If the provisions of Article 21-5-4, paragraph (3) are applied to payment of exceptional case outpatient benefits for children with disabilities received by a recognized outpatient beneficiary custodian specified in the preceding paragraph, the term "a municipality is to determine based on the amount obtained by deducting" is replaced with "the amount obtained by deducting the amount determined by a municipality within the extent".

第二十一条の五の十二市町村は、通所給付決定保護者が受けた障害児通所支援に要した費用の合計額（厚生労働大臣が定める基準により算定した費用の額（その額が現に要した費用の額を超えるときは、当該現に要した額）の合計額を限度とする。）から当該費用につき支給された障害児通所給付費及び特例障害児通所給付費の合計額を控除して得た額が、著しく高額であるときは、当該通所給付決定保護者に対し、高額障害児通所給付費を支給する。

Article 21-5-12(1)If the amount of the expenses spent for outpatient support for children with disabilities received by a recognized outpatient beneficiary custodian obtained (in the case the amount actually required exceeds the amount calculated from the standard specified by Minister of Health, Labour and Welfare, the relevant amount actually required) by deducting the total amount of outpatient benefits for children with disabilities and exceptional case outpatient benefits for children with disabilities paid in relation to the relevant expenses is extremely costly, a municipality must pay high-cost outpatient benefits for children with disabilities to the relevant mount of the expenses spent for outpatient support received by a recognized outpatient beneficiary custodian.

２前項に定めるもののほか、高額障害児通所給付費の支給要件、支給額その他高額障害児通所給付費の支給に関し必要な事項は、指定通所支援に要する費用の負担の家計に与える影響を考慮して、政令で定める。

(2)Beyond what is provided for in the preceding paragraph, necessary particulars for requirements for payment of high-cost outpatient benefits for children with disabilities, grant amount, other particulars concerning payment of high-cost outpatient benefits for children with disabilities is prescribed in Cabinet Order by considering impact of the burden of expenses spent for designated outpatient support on household finances.

第二十一条の五の十三市町村は、第二十一条の五の三第一項、第二十一条の五の四第一項又は前条第一項の規定にかかわらず、放課後等デイサービスを受けている障害児（以下この項において「通所者」という。）について、引き続き放課後等デイサービスを受けなければその福祉を損なうおそれがあると認めるときは、当該通所者が満十八歳に達した後においても、当該通所者からの申請により、当該通所者が満二十歳に達するまで、厚生労働省令で定めるところにより、引き続き放課後等デイサービスに係る障害児通所給付費、特例障害児通所給付費又は高額障害児通所給付費（次項において「放課後等デイサービス障害児通所給付費等」という。）を支給することができる。ただし、当該通所者が障害者の日常生活及び社会生活を総合的に支援するための法律第五条第七項に規定する生活介護その他の支援を受けることができる場合は、この限りでない。

Article 21-5-13(1)With regard to a child with disabilities who receives after school day services (referring to as "attendee" in this paragraph), if it is found that the welfare of the relevant attendee is likely to be impaired unless their receipt of such services is continued, a municipality may, notwithstanding the provisions of Article 21-5-3, paragraph (1), Article 21-5, paragraph (1) or paragraph (1) of the preceding Article, continue the payment of outpatient benefits for children with disabilities, exceptional case outpatient benefits for children with disabilities or high-cost outpatient benefits for children with disabilities (referring to as "outpatient benefits, etc. of after school day services for children with disabilities" in the following paragraph) pertaining to after school day services, based on the relevant attendee's application, pursuant to the provisions of Order of Ministry of Health, Labour and Welfare even after the child attains the age of 18 until they become 20 years of age.; provided, however, that this does not apply to the case where the relevant attendee can receive the public assistance provided in Article 5, paragraph (7) of the Act on the Comprehensive Support for the Daily and Life in Society of Persons with Disabilities or other support.

２前項の規定により放課後等デイサービス障害児通所給付費等を支給することができることとされた者については、その者を障害児又は障害児の保護者とみなして、第二十一条の五の三から前条までの規定を適用する。この場合において、必要な技術的読替えその他これらの規定の適用に関し必要な事項は、政令で定める。

(2)With regard to a person who is eligible for receiving payment of benefits, etc. of after school day services for children with disabilities pursuant to the provisions of the preceding paragraph, they are deemed to be children with disabilities or the custodian of a child with disabilities and the provisions of Articles 21-5-3 through the preceding Article apply mutatis mutandis.In this case, necessary terminological replacements are prescribed by a Cabinet Order.

３市町村は、第一項の場合において必要があると認めるときは、児童相談所等の意見を聴くことができる。

(3)In the event that a municipality acknowledges it is necessary to make a decision, if it is found to be necessary in the case of paragraph (1), a municipality may hear the opinions from child guidance centers.

第二十一条の五の十四この款に定めるもののほか、障害児通所給付費、特例障害児通所給付費又は高額障害児通所給付費の支給及び指定障害児通所支援事業者等の障害児通所給付費の請求に関し必要な事項は、厚生労働省令で定める。

Article 21-5-14Beyond what is provided for in this subsection, necessary particulars for payment of outpatient benefits for children with disabilities, exceptional case outpatient benefits for children with disabilities or high-cost outpatient benefits for children with disabilities and claim for outpatient benefits for designated operator, etc. of outpatient support services for children with disabilities is specified by Order of Ministry of Health, Labour and Welfare.

第二十一条の五の十五第二十一条の五の三第一項の指定は、厚生労働省令で定めるところにより、障害児通所支援事業を行う者の申請により、障害児通所支援の種類及び障害児通所支援事業を行う事業所（以下「障害児通所支援事業所」という。）ごとに行う。

Article 21-5-15(1)Designation set forth in Article 21-5-3, paragraph (1) is conducted for each type of outpatient support and each office that provides outpatient support services for children with disabilities (hereinafter referred to as "outpatient support office for children with disabilities") pursuant to the provisions of Order of Ministry of Health, Labour and Welfare, based on application by the persons who provide outpatient support services for children with disabilities.

２放課後等デイサービスその他の厚生労働省令で定める障害児通所支援（以下この項及び第五項並びに第二十一条の五の二十第一項において「特定障害児通所支援」という。）に係る第二十一条の五の三第一項の指定は、当該特定障害児通所支援の量を定めてするものとする。

(2)The designation of Article 21-5-3, paragraph (1) pertaining to after school day services and other outpatient support prescribed in Order of the Ministry of Health, Labour and Welfare (referring to as "outpatient support for specified children with disabilities" in this paragraph and paragraph (5) and Article 21-5-20, paragraph (1)) is to determine the amount of the relevant outpatient support for specified children with disabilities.

３都道府県知事は、第一項の申請があつた場合において、次の各号（医療型児童発達支援に係る指定の申請にあつては、第七号を除く。）のいずれかに該当するときは、指定障害児通所支援事業者の指定をしてはならない。

(3)A prefectural governor must not make a designation of designated operator of outpatient support services for children with disabilities if an application referred to in paragraph (1) is filed and the filed application falls under any of the following items (excluding item (vii) in case of the application of medical services child developmental support):

４都道府県が前項第一号の条例を定めるに当たつては、厚生労働省令で定める基準に従い定めるものとする。

(4)A prefecture is to specify the Prefectural Ordinances of item (i) of the preceding paragraph pursuant to the standard of Order of Ministry of Health, Labour and Welfare.

５都道府県知事は、特定障害児通所支援につき第一項の申請があつた場合において、当該都道府県又は当該申請に係る障害児通所支援事業所の所在地を含む区域（第三十三条の二十二第二項第二号の規定により都道府県が定める区域をいう。）における当該申請に係る種類ごとの指定通所支援の量が、同条第一項の規定により当該都道府県が定める都道府県障害児福祉計画において定める当該都道府県若しくは当該区域の当該指定通所支援の必要な量に既に達しているか、又は当該申請に係る事業者の指定によつてこれを超えることになると認めるとき、その他の当該都道府県障害児福祉計画の達成に支障を生ずるおそれがあると認めるときは、第二十一条の五の三第一項の指定をしないことができる。

(5)If the application under paragraph (1) has been filed, the prefectural governor may determine not to grant an designation under Article 21-5-3, paragraph (1), in cases where it is found that the amount of designated outpatient support for children with disabilities for each type pertaining to the relevant application in the area including the location of the outpatient support office for children with disabilities pertaining to the relevant prefecture or the relevant application (referring to the area specified by the prefecture pursuant to the provisions of Article 33-22, paragraph (2), item (ii)) has already reached to the amount necessary for the relevant prefecture or the relevant area specified in the prefectural welfare plan for children with disabilities determined by the relevant prefecture pursuant to the provisions of paragraph (1) of the same Article or the relevant amount may be exceeded by designation of the service office pertaining to the relevant application and that it is likely to cause problems with accomplishment of the prefectural welfare plan for children with disabilities.

第二十一条の五の十六第二十一条の五の三第一項の指定は、六年ごとにその更新を受けなければ、その期間の経過によつて、その効力を失う。

Article 21-5-16(1)Unless the designation of Article 21-5-3, paragraph (1) is renewed every six years, the designation ceases to be effective upon the expiration of such period.

２前項の更新の申請があつた場合において、同項の期間（以下この条において「指定の有効期間」という。）の満了の日までにその申請に対する処分がされないときは、従前の指定は、指定の有効期間の満了後もその処分がされるまでの間は、なおその効力を有する。

(2)In the case where a renewal set forth in the preceding paragraph is applied, when no disposition is implemented for the application by the expiration date of the period set forth in the same paragraph (referred to as a "effective period for designation" hereinafter in this Article), the designation before the renewal remains in force until the disposition is implemented, even after the expiration of the effective period for designation.

３前項の場合において、指定の更新がされたときは、その指定の有効期間は、従前の指定の有効期間の満了の日の翌日から起算するものとする。

(3)When the designation is renewed in the case referred to in the preceding paragraph, the effective period for designation as renewed starts from the day following the expiration date of the effective period for designation before the renewal.

４前条の規定は、第一項の指定の更新について準用する。この場合において、必要な技術的読替えは、政令で定める。

(4)The provisions of the preceding Article apply mutatis mutandis to renewal of designation set forth in paragraph (1).In this case, necessary terminological replacements are prescribed by a Cabinet Order.

第二十一条の五の十七児童発達支援その他厚生労働省令で定める障害児通所支援に係る障害児通所支援事業所について、介護保険法（平成九年法律第百二十三号）第四十一条第一項本文の指定（当該障害児通所支援事業所により行われる障害児通所支援の種類に応じて厚生労働省令で定める種類の同法第八条第一項に規定する居宅サービスに係るものに限る。）、同法第四十二条の二第一項本文の指定（当該障害児通所支援事業所により行われる障害児通所支援の種類に応じて厚生労働省令で定める種類の同法第八条第十四項に規定する地域密着型サービスに係るものに限る。）、同法第五十三条第一項本文の指定（当該障害児通所支援事業所により行われる障害児通所支援の種類に応じて厚生労働省令で定める種類の同法第八条の二第一項に規定する介護予防サービスに係るものに限る。）若しくは同法第五十四条の二第一項本文の指定（当該障害児通所支援事業所により行われる障害児通所支援の種類に応じて厚生労働省令で定める種類の同法第八条の二第十二項に規定する地域密着型介護予防サービスに係るものに限る。）又は障害者の日常生活及び社会生活を総合的に支援するための法律第二十九条第一項の指定障害福祉サービス事業者の指定（当該障害児通所支援事業所により行われる障害児通所支援の種類に応じて厚生労働省令で定める種類の同法第五条第一項に規定する障害福祉サービスに係るものに限る。）を受けている者から当該障害児通所支援事業所に係る第二十一条の五の十五第一項（前条第四項において準用する場合を含む。）の申請があつた場合において、次の各号のいずれにも該当するときにおける第二十一条の五の十五第三項（前条第四項において準用する場合を含む。以下この項において同じ。）の規定の適用については、第二十一条の五の十五第三項第二号中「第二十一条の五の十九第一項の」とあるのは「第二十一条の五の十七第一項第一号の指定通所支援に従事する従業者に係る」と、同項第三号中「第二十一条の五の十九第二項」とあるのは「第二十一条の五の十七第一項第二号」とする。ただし、申請者が、厚生労働省令で定めるところにより、別段の申出をしたときは、この限りでない。

Article 21-5-17(1)With regard to child developmental support and other outpatient support office for children with disabilities pertaining to other outpatient support services for children with disabilities specified by Order of Ministry of Health, Labour and Welfare, in the case where application of Article 21-5-15, paragraph (1) (which includes applying mutatis mutandis in paragraph (4) of the preceding Article) pertaining to the relevant outpatient support office for children with disabilities is filed from the person who was granted the designation in the text of Article 41, paragraph (1) of Long-term Care Insurance Act (Act No. 123 of 1997) (limited to the one pertaining in-home services specified by Article 8, paragraph (1) of the same Act of the categories specified by Order of Ministry of Health, Labour and Welfare, in accordance with the categories of outpatient support for children with disabilities practiced by the relevant outpatient support office for children with disabilities), the designation in the text of Article 42-2, paragraph (1) of the same Act (limited to the one pertaining community-based services specified by Article 8, paragraph (14) of the same Act of the categories specified by Order of Ministry of Health, Labour and Welfare, in accordance with the categories of outpatient support for children with disabilities practiced by the relevant outpatient support office for children with disabilities), the designation in the text of Article 53, paragraph (1) of the same Act (limited to the one pertaining preventive long-term care services specified by Article 8-2, paragraph (1) of the same Act of the categories specified by Order of Ministry of Health, Labour and Welfare, in accordance with the categories of outpatient support for children with disabilities practiced by the relevant outpatient support office for children with disabilities), or the designation in the text of Article 54-2, paragraph (1) of the same Act or the designation of the designated operator of welfare service for persons with disabilities of Article 29, paragraph (1) of Act on the Comprehensive Support for the Daily and Life in Society of Persons with Disabilities (limited to the one pertaining to welfare services for persons with disabilities specified by Article 5, paragraph (1) of the same Act of the categories specified by Order of Ministry of Health, Labour and Welfare, in accordance with the categories of outpatient support services for children with disabilities practiced by the relevant outpatient support services office for children with disabilities) regarding application of the provisions of Article 21-5-15, paragraph (3) which includes applying mutatis mutandis in paragraph (4) of the preceding Article; hereinafter the same applies in this paragraph) in the case where such application falls under all the following items, "of Article 21-5-19, paragraph (1)" is replace with "pertaining to the employees engaged in designated outpatient support of Article 21-5-17, paragraph (1), item (i), and "Article 21-5-19, paragraph (2)" of item (iii) of the same paragraph with "Article 21-5-17, paragraph (1), item (ii)" respectively; provided, however, that these provisions do not apply when the applicant makes a special notification pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

２都道府県が前項各号の条例を定めるに当たつては、第一号から第三号までに掲げる事項については厚生労働省令で定める基準に従い定めるものとし、第四号に掲げる事項については厚生労働省令で定める基準を標準として定めるものとし、その他の事項については厚生労働省令で定める基準を参酌するものとする。

(2)The provisions of all the items of the preceding paragraph are specified in accordance with the standards specified by Order of Ministry of Health, Labour and Welfare concerning the particulars listed in through items (i) through (iii); the particulars of item (iv) is specified by setting based on the standard provided in Order of the Ministry of Health, Labour and Welfare and other particulars are specified by taking into consideration the standard provided in Order of the Ministry of Health, Labour and Welfare.

３第一項の場合において、同項に規定する者が同項の申請に係る第二十一条の五の三第一項の指定を受けたときは、その者に対しては、第二十一条の五の十九第三項の規定は適用せず、次の表の上欄に掲げる規定の適用については、これらの規定中同表の中欄に掲げる字句は、それぞれ同表の下欄に掲げる字句とする。

(3)In the paragraph (1), in the case where a person prescribed in the same paragraph receive designation of Article 21-5-3, paragraph (1) pertaining to the application of the same paragraph, for such person, the provisions of Article 21-5-19, paragraph (3) are not applicable; with regard to application of the provisions listed in the left column of the following table, the letters listed in the middle column are to correspond to the letters of the right column of the same table.

４第一項に規定する者であつて、同項の申請に係る第二十一条の五の三第一項の指定を受けたものから、次の各号のいずれかの届出があつたときは、当該指定に係る指定通所支援の事業について、第二十一条の五の二十第四項の規定による事業の廃止又は休止の届出があつたものとみなす。

(4)If the notification is made for any of the following items by the person specified in paragraph (1) who was granted designation of Article 21-5-3, paragraph (1) pertaining to the application of the same paragraph, it is deemed as notification of abolishment or suspension pursuant to the provisions of Article 21-5-20, paragraph (4) with regard to the designated outpatient support services pertaining to the relevant designation.

５第一項に規定する者であつて、同項の申請に係る第二十一条の五の三第一項の指定を受けたものは、介護保険法第四十二条の二第一項に規定する指定地域密着型サービスの事業（当該指定に係る障害児通所支援事業所において行うものに限る。）又は同法第五十四条の二第一項に規定する指定地域密着型介護予防サービスの事業（当該指定に係る障害児通所支援事業所において行うものに限る。）を廃止し、又は休止しようとするときは、厚生労働省令で定めるところにより、その廃止又は休止の日の一月前までに、その旨を当該指定を行つた都道府県知事に届け出なければならない。この場合において、当該届出があつたときは、当該指定に係る指定通所支援の事業について、第二十一条の五の二十第四項の規定による事業の廃止又は休止の届出があつたものとみなす。

(5)If the person specified in paragraph (1) who was granted designation of Article 21-5-3, paragraph (1), intends to abolish or suspend the services of the designated community-based service specified in Article 42-2, paragraph (1) of the Long-Term Care Insurance Act (limited to the services provided in outpatient support office for children with disabilities pertaining to the relevant designation) or the services of the designated community-based preventative long-term care service specified in Article 54-2, paragraph (1) of the same Act (limited to the services provided in outpatient support office for children with disabilities pertaining to the relevant designation), pursuant to the provisions of Order of Ministry of Health, Labour and Welfare, by one month prior to the date of abolishment or suspension, the person must notify to that effect to the prefectural governor who has made the relevant designation.In this case, if the relevant notification is made, the relevant person is deemed to notify abolishment or suspension of the services pursuant to the provisions of Article 21-5-20, paragraph (4).

第二十一条の五の十八指定障害児通所支援事業者及び指定発達支援医療機関の設置者（以下「指定障害児事業者等」という。）は、障害児が自立した日常生活又は社会生活を営むことができるよう、障害児及びその保護者の意思をできる限り尊重するとともに、行政機関、教育機関その他の関係機関との緊密な連携を図りつつ、障害児通所支援を当該障害児の意向、適性、障害の特性その他の事情に応じ、常に障害児及びその保護者の立場に立つて効果的に行うように努めなければならない。

Article 21-5-18(1)In order to enable a child with disabilities to lead self-reliant daily life or social life, the establisher of a designated operator of outpatient support services for children with disabilities and designated developmental support medical institution (hereinafter referred to as "designated services operator, etc. for children with disabilities") must endeavor to effectively implement outpatient support for children with disabilities according to the intention, aptitudes, characteristics of dysfunctions and other circumstances of relevant child with disabilities, while facilitating close coordination with administrative organs, educational institutions and other relevant bodies, as well as respecting the willing of a child with disabilities or their custodian as much as possible constantly from the standpoint of children with disabilities and their custodians.

２指定障害児事業者等は、その提供する障害児通所支援の質の評価を行うことその他の措置を講ずることにより、障害児通所支援の質の向上に努めなければならない。

(2)The designated services operator, etc. for children with disabilities must endeavor to improve the quality of outpatient support for children with disabilities by evaluating the quality of outpatient support for children with disabilities provided by such operator and taking other measures.

３指定障害児事業者等は、障害児の人格を尊重するとともに、この法律又はこの法律に基づく命令を遵守し、障害児及びその保護者のため忠実にその職務を遂行しなければならない。

(3)The designated services operator, etc. for children with disabilities must respect the personality of children with disabilities, comply with this Act and the orders based on this Act, and implement their duties faithfully for children with disabilities and their custodians.

第二十一条の五の十九指定障害児事業者等は、都道府県の条例で定める基準に従い、当該指定に係る障害児通所支援事業所又は指定発達支援医療機関ごとに、当該指定通所支援に従事する従業者を有しなければならない。

Article 21-5-19(1)The designated services operator, etc. for children with disabilities must have employees engaged in the relevant designated outpatient support, per outpatient support office for children with disabilities or per designated developmental support medical provider institution pertaining to the relevant designation in accordance with the standard specified in the Prefectural Ordinance.

２指定障害児事業者等は、都道府県の条例で定める指定通所支援の事業の設備及び運営に関する基準に従い、指定通所支援を提供しなければならない。

(2)The designated services operator, etc. for children with disabilities must provide the designated outpatient support in accordance with the standard relating to equipment and operation of the services of the designated outpatient support specified in the Prefectural Ordinance.

３都道府県が前二項の条例を定めるに当たつては、第一号から第三号までに掲げる事項については厚生労働省令で定める基準に従い定めるものとし、第四号に掲げる事項については厚生労働省令で定める基準を標準として定めるものとし、その他の事項については厚生労働省令で定める基準を参酌するものとする。

(3)The provisions of the preceding two items are specified in accordance with the standards specified by Order of Ministry of Health, Labour and Welfare concerning the particulars listed through items (i) through (iii); the particulars of item (iv) are specified by setting based on the standards provided in Order of the Ministry of Health, Labour and Welfare and other particulars are be specified by taking into consideration the standards provided in Order of the Ministry of Health, Labour and Welfare.

４指定障害児通所支援事業者は、次条第四項の規定による事業の廃止又は休止の届出をしたときは、当該届出の日前一月以内に当該指定通所支援を受けていた者であつて、当該事業の廃止又は休止の日以後においても引き続き当該指定通所支援に相当する支援の提供を希望する者に対し、必要な障害児通所支援が継続的に提供されるよう、他の指定障害児事業者等その他関係者との連絡調整その他の便宜の提供を行わなければならない。

(4)If the designated operator of outpatient support services for children with disabilities notifies abolishment or suspension of the services pursuant to the provisions of paragraph (4) of the following Article, for the person who receives the relevant designated outpatient support within one month prior to the date of the relevant notification and the person who seeks to continue provision of support corresponding to the relevant designated outpatient support even after the date of abolishment or suspension of the relevant services, such operator must carry out liaison and coordination with other designated outpatient services operators, etc. for children with disabilities and other relevant persons and provide other benefits in order to continuously provide necessary outpatient support for children with disabilities.

第二十一条の五の二十指定障害児通所支援事業者は、第二十一条の五の三第一項の指定に係る特定障害児通所支援の量を増加しようとするときは、厚生労働省令で定めるところにより、同項の指定の変更を申請することができる。

Article 21-5-20(1)If the designated operator of outpatient support services for children with disabilities intends to increase the amount of outpatient support for specified children with disabilities pertaining to the designation of Article 21-5-3, paragraph (1), the operator may apply alternation of designation of the same paragraph pursuant to the Order of Ministry of Health, Labour and Welfare.

２第二十一条の五の十五第三項から第五項までの規定は、前項の指定の変更の申請があつた場合について準用する。この場合において、必要な技術的読替えは、政令で定める。

(2)The provisions of Article 21-5-15, paragraph (3) through (5) apply mutatis mutandis to the case where application for alternation of the designation in the preceding paragraph is made.In this case, necessary terminological replacements are prescribed by Cabinet Order.

３指定障害児通所支援事業者は、当該指定に係る障害児通所支援事業所の名称及び所在地その他厚生労働省令で定める事項に変更があつたとき、又は休止した当該指定通所支援の事業を再開したときは、厚生労働省令で定めるところにより、十日以内に、その旨を都道府県知事に届け出なければならない。

(3)If the designated operator of outpatient support services for children with disabilities changes the name and location of outpatient support office for children with disabilities pertaining to the relevant designation and other particulars set forth in Order of the Ministry of Health, Labour and Welfare is made, or the services of the relevant designated outpatient support whose operation had been suspended resumed, the operator must notify that effect to the prefectural governor within ten days.

４指定障害児通所支援事業者は、当該指定通所支援の事業を廃止し、又は休止しようとするときは、厚生労働省令で定めるところにより、その廃止又は休止の日の一月前までに、その旨を都道府県知事に届け出なければならない。

(4)If the designated operator of outpatient support services for children with disabilities intends to abolish or suspend the services of the relevant designated outpatient support for children with disabilities, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, the operator must notify the prefectural governor by one month prior to the date of abolishment or suspension.

第二十一条の五の二十一都道府県知事又は市町村長は、第二十一条の五の十九第四項に規定する便宜の提供が円滑に行われるため必要があると認めるときは、当該指定障害児通所支援事業者その他の関係者相互間の連絡調整又は当該指定障害児通所支援事業者その他の関係者に対する助言その他の援助を行うことができる。

Article 21-5-21(1)If a prefectural governor or municipal mayor is found to be necessary to smoothly provide the benefits specified in Article 21-5-21, the governor and mayor may carry out mutual liaison and coordination with the relevant designated operator of outpatient support services for children with disabilities and other relevant persons or provide advice and other assistance for the relevant designated operator of outpatient support services for children with disabilities and other relevant persons,

２厚生労働大臣は、同一の指定障害児通所支援事業者について二以上の都道府県知事が前項の規定による連絡調整又は援助を行う場合において、第二十一条の五の十九第四項に規定する便宜の提供が円滑に行われるため必要があると認めるときは、当該都道府県知事相互間の連絡調整又は当該指定障害児通所支援事業者に対する都道府県の区域を超えた広域的な見地からの助言その他の援助を行うことができる。

(2)Minister of Health, Labor and Welfare, in the case of liaison and coordination or assistance pursuant to the preceding paragraph by two or more prefectural governors regarding the identical designated operator of outpatient support services for children with disabilities, if it is found necessary for smooth provision of benefits specified in Article 21-5-19, paragraph (4), may provide mutual liaison and coordination between the relevant prefectures, advice and other assistance from a cross-regional viewpoint beyond the areas of the prefectures for the relevant designated operator of outpatient support services for children with disabilities.

第二十一条の五の二十二都道府県知事又は市町村長は、必要があると認めるときは、指定障害児通所支援事業者若しくは指定障害児通所支援事業者であつた者若しくは当該指定に係る障害児通所支援事業所の従業者であつた者（以下この項において「指定障害児通所支援事業者であつた者等」という。）に対し、報告若しくは帳簿書類その他の物件の提出若しくは提示を命じ、指定障害児通所支援事業者若しくは当該指定に係る障害児通所支援事業所の従業者若しくは指定障害児通所支援事業者であつた者等に対し出頭を求め、又は当該職員に、関係者に対し質問させ、若しくは当該指定障害児通所支援事業者の当該指定に係る障害児通所支援事業所、事務所その他当該指定通所支援の事業に関係のある場所に立ち入り、その設備若しくは帳簿書類その他の物件を検査させることができる。

Article 21-5-22(1)When a prefectural governor or municipal mayor finds it to be necessary, they may make the relevant officials or relevant persons, for a person who used to be a designated operator of outpatient support services for children with disabilities, or its employee, (hereinafter referred to as "a person who used to be a designated operator, etc. of outpatient support services for children with disabilities") pertaining to the relevant designation, report or submit or present books and documents and other objects, request the appearance of a person who was used to be a designated operator of outpatient support services for children with disabilities, or may make relevant prefecture's official ask relevant persons questions or enter any office of the outpatient support office pertaining the relevant designated operator of outpatient support services for children with disabilities, any office or other location of the services of the relevant designated outpatient support and inspect its equipment, books and documents and other objects.

２前項の規定は、指定発達支援医療機関の設置者について準用する。この場合において、必要な技術的読替えは、政令で定める。

(2)The provisions of the preceding paragraph apply mutatis mutandis to the establisher of the designated developmental support medical institution.In this case, necessary technical replacement of the terms in this case are provided by Cabinet Order.

３第十九条の十六第二項の規定は第一項（前項において準用する場合を含む。）の規定による質問又は検査について、同条第三項の規定は第一項（前項において準用する場合を含む。）の規定による権限について準用する。

(3)The provisions of Article 19-16, paragraph (2) apply mutatis mutandis to the questions and inspection pursuant to the provisions of paragraph (1), and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority pursuant to the provisions of paragraph (1) (including application mutatis mutandis to the preceding paragraph).

第二十一条の五の二十三都道府県知事は、指定障害児事業者等が、次の各号（指定発達支援医療機関の設置者にあつては、第三号を除く。以下この項及び第五項において同じ。）に掲げる場合に該当すると認めるときは、当該指定障害児事業者等に対し、期限を定めて、当該各号に定める措置をとるべきことを勧告することができる。

Article 21-5-23(1)If the prefectural governor finds that the designated operator, etc. for children with disabilities falls under the cases listed in all the following items (excluding item (iii) for the establisher of the designated developmental support medical institution; the same applies to this paragraph and paragraph (5).), the prefectural governor may recommend the measures to be taken specified in the relevant items, for the relevant designated operator, etc. for children with disabilities by a set deadline.

２都道府県知事は、前項の規定による勧告をした場合において、その勧告を受けた指定障害児事業者等が、同項の期限内にこれに従わなかつたときは、その旨を公表することができる。

(2)the prefectural governor, in the case where recommendation is made pursuant to the provisions of the preceding paragraph and the designated operator, etc. for children with disabilities does not comply with such recommendation within the period of the same paragraph, may issue a public announcement to that effect.

３都道府県知事は、第一項の規定による勧告を受けた指定障害児事業者等が、正当な理由がなくてその勧告に係る措置をとらなかつたときは、当該指定障害児事業者等に対し、期限を定めて、その勧告に係る措置をとるべきことを命ずることができる。

(3)the prefectural governor, in the case the designated operator, etc. for children with disabilities who has received recommendation pursuant to the provisions of paragraph (1) does not take measures pertaining to such recommendation without justifiable grounds, may order the relevant designated operator, etc. for children with disabilities to take measures pertaining to such recommendation by a set deadline.

４都道府県知事は、前項の規定による命令をしたときは、その旨を公示しなければならない。

(4)The prefectural governor must notify the public to that effect, in the event of issuing an order pursuant to the preceding paragraph.

５市町村は、障害児通所給付費の支給に係る指定通所支援を行つた指定障害児事業者等について、第一項各号に掲げる場合のいずれかに該当すると認めるときは、その旨を当該指定に係る障害児通所支援事業所又は指定発達支援医療機関の所在地の都道府県知事に通知しなければならない。

(5)If a municipality finds that the designated operator, etc. for children with disabilities who provided the designated outpatient support pertaining to payment of outpatient benefits for children with disabilities falls under any of the cases listed in the items of paragraph (1), the municipality must notify the prefectural governor of the location of outpatient support office for children with disabilities or the designated developmental support medical institution pertaining to the relevant designation to that effect.

第二十一条の五の二十四都道府県知事は、次の各号のいずれかに該当する場合においては、当該指定障害児通所支援事業者に係る第二十一条の五の三第一項の指定を取り消し、又は期間を定めてその指定の全部若しくは一部の効力を停止することができる。

Article 21-5-24(1)The prefectural governor, in the case of falling under any of the following items, may rescind the designation set forth in Article 21-5-3, paragraph (1) pertaining to the relevant designated operator of outpatient support services for children with disabilities or suspend the validity of the designation, in whole or in part, for a period of time to be specified:

２市町村は、障害児通所給付費等の支給に係る障害児通所支援又は肢体不自由児通所医療費の支給に係る第二十一条の五の二十九第一項に規定する肢体不自由児通所医療を行つた指定障害児通所支援事業者について、前項各号のいずれかに該当すると認めるときは、その旨を当該指定に係る障害児通所支援事業所の所在地の都道府県知事に通知しなければならない。

(2)A municipality must, if it is found that the designated operator of outpatient support services for children with disabilities who has provided outpatient support for children with disabilities pertaining to payment of outpatient benefits, etc. for children with disabilities or outpatient medical treatment for orthopedically impaired children specified by Article 21-5-29, paragraph (1) pertaining to payment of outpatient medical expenses for orthopedically impaired children falls under any of the items of the preceding paragraph, notify the prefectural governor of the location of outpatient support office for children with disabilities pertaining to the relevant designation to that effect.

第二十一条の五の二十五都道府県知事は、次に掲げる場合には、その旨を公示しなければならない。

Article 21-5-25A prefectural governor must give public notice in any of the cases listed in the following items to that effect:

第二十一条の五の二十六指定障害児事業者等は、第二十一条の五の十八第三項に規定する義務の履行が確保されるよう、厚生労働省令で定める基準に従い、業務管理体制を整備しなければならない。

Article 21-5-26(1)The designated operator, etc. for children with disabilities must establish a management system in accordance with the requirements specified by Order of the Ministry of Health, Labour and Welfare to ensure that the duties prescribed in Article 21-5-18, paragraph (3) are carried out.

２指定障害児事業者等は、次の各号に掲げる区分に応じ、当該各号に定める者に対し、厚生労働省令で定めるところにより、業務管理体制の整備に関する事項を届け出なければならない。

(2)The designated operator, etc. for children with disabilities, according to their category set forth in the relevant following items, must give notification of particulars pertaining to the establishment of a management system to the relevant person specified in that item, in accordance with Order of the Ministry of Health, Labour and Welfare:

３前項の規定により届出をした指定障害児事業者等は、その届け出た事項に変更があつたときは、厚生労働省令で定めるところにより、遅滞なく、その旨を当該届出をした厚生労働大臣、都道府県知事又は指定都市若しくは中核市の長（以下この款において「厚生労働大臣等」という。）に届け出なければならない。

(3)If any changes have been made to the particulars in the notification which the designated operator, etc. for children with disabilities made pursuant to the preceding paragraph, that designated operator, etc. must give notification to the effect without delay to the Minister of Health, Labour and Welfare, the prefectural governor, or the mayor of the designated city or core city (hereinafter referred to as the "Minister of Health, Labour and Welfare, etc." in this subsection) to whom they gave the notification in question, in accordance with Order of the Ministry of Health, Labour and Welfare.

４第二項の規定による届出をした指定障害児通所支援事業者は、同項各号に掲げる区分の変更により、同項の規定により当該届出をした厚生労働大臣等以外の厚生労働大臣等に届出を行うときは、厚生労働省令で定めるところにより、その旨を当該届出をした厚生労働大臣等にも届け出なければならない。

(4)If the designated operator of outpatient support services for children with disabilities business that gave the Minister of Health, Labour and Welfare, etc. the notification under paragraph (2) gives notification to another Minister, etc. other than that Minister, etc. pursuant to the same paragraph due to a change in their category set forth in the items of the same paragraph, they must also give notification to the effect to that Minister, etc. in accordance with Order of the Ministry of Health, Labour and Welfare.

５厚生労働大臣等は、前三項の規定による届出が適正になされるよう、相互に密接な連携を図るものとする。

(5)The Ministers of Health, Labour and Welfare, etc. must endeavor to coordinate closely with each other to ensure that the notification under the preceding three paragraphs are made appropriately.

第二十一条の五の二十七前条第二項の規定による届出を受けた厚生労働大臣等は、当該届出をした指定障害児事業者等（同条第四項の規定による届出を受けた厚生労働大臣等にあつては、同項の規定による届出をした指定障害児通所支援事業者を除く。）における同条第一項の規定による業務管理体制の整備に関して必要があると認めるときは、当該指定障害児事業者等に対し、報告若しくは帳簿書類その他の物件の提出若しくは提示を命じ、当該指定障害児事業者等若しくは当該指定障害児事業者等の従業者に対し出頭を求め、又は当該職員に、関係者に対し質問させ、若しくは当該指定障害児事業者等の当該指定に係る障害児通所支援事業所、事務所その他の指定通所支援の提供に関係のある場所に立ち入り、その設備若しくは帳簿書類その他の物件を検査させることができる。

Article 21-5-27(1)If the Minister of Health, Labour and Welfare, etc. who has receive a notification under paragraph (2) of the preceding Article finds it necessary for the establishment of the a management system under paragraph (1) of the same Article for the designated operator, etc. for children with disabilities (excluding the designated operator of outpatient support services for children with disabilities that has filed a notification under paragraph (4) the same Article, in cases of the Minister of Health, Labour and Welfare, etc. who has received the notification), they may order that designated operator to make a report; order them to submit or show books, documents or other materials; request that operator or their employees to appear; require the relevant personnel to question the persons concerned; or require them to reenter the places of outpatient support office for children with disabilities or offices relevant to their designation, or enter other places related to the provision of the designated outpatient support services for children with disabilities, in order to inspect the equipment, books, documents or other materials.

２厚生労働大臣又は指定都市若しくは中核市の長が前項の権限を行うときは、当該指定障害児通所支援事業者に係る指定を行つた都道府県知事（次条第五項において「関係都道府県知事」という。）と密接な連携の下に行うものとする。

(2)If the Minister of Health, Labour and Welfare or the mayor of a designated city or core city exercises the authority prescribed in the preceding paragraph, they are to do so in close cooperation with the prefectural governor who conferred the designation upon the designated operator of outpatient support services for children with disabilities (referred to as the "relevant prefectural governor" in paragraph (5) of the following Article).

３都道府県知事は、その行つた又はその行おうとする指定に係る指定障害児通所支援事業者における前条第一項の規定による業務管理体制の整備に関して必要があると認めるときは、厚生労働大臣又は指定都市若しくは中核市の長に対し、第一項の権限を行うよう求めることができる。

(3)When the prefectural governor finds it necessary for the establishment of a management system under paragraph (1) of the preceding article for the designated operator of outpatient support services for children with disabilities relevant to the designation which that prefectural governor conferred or intends to confer, the prefectural governor may request the Minister of Health, Labour and Welfare or the mayor of a designated city or core city to exercise the authority set forth in paragraph (1).

４厚生労働大臣又は指定都市若しくは中核市の長は、前項の規定による都道府県知事の求めに応じて第一項の権限を行つたときは、厚生労働省令で定めるところにより、その結果を当該権限を行うよう求めた都道府県知事に通知しなければならない。

(4)If the Minister of Health, Labour and Welfare or the mayor of the designated city or core city exercises the authority prescribed in paragraph (1) in response to a request made by the prefectural governor pursuant to the preceding paragraph, they must make the notification of the results to that prefectural governor who made that request, in accordance with Order of the Ministry of Health, Labour and Welfare.

５第十九条の十六第二項の規定は第一項の規定による質問又は検査について、同条第三項の規定は第一項の規定による権限について準用する。

(5)The provisions of Article 19-16, paragraph (2) apply mutatis mutandis to the questioning and inspection under paragraph (1) of this Article; the provisions of paragraph (3) of Article 19-16 apply mutatis mutandis to the authority under paragraph (1) of this Article.

第二十一条の五の二十八第二十一条の五の二十六第二項の規定による届出を受けた厚生労働大臣等は、当該届出をした指定障害児事業者等（同条第四項の規定による届出を受けた厚生労働大臣等にあつては、同項の規定による届出をした指定障害児通所支援事業者を除く。）が、同条第一項の厚生労働省令で定める基準に従つて適正な業務管理体制の整備をしていないと認めるときは、当該指定障害児事業者等に対し、期限を定めて、当該厚生労働省令で定める基準に従つて適正な業務管理体制を整備すべきことを勧告することができる。

Article 21-5-28(1)If the Minister of Health, Labour and Welfare, etc. who has received the notification under Article 21-5-26, paragraph (2) finds that the designated operator, etc. for children with disabilities that has filed the notification (in the case of the Minister of Health, Labour and Welfare, etc. who has received a notification pursuant to paragraph (4) of the same Article, this does not include the designated operator of outpatient support services for children with disabilities who made the notification pursuant to the same paragraph) does not establish an appropriate management system, the Minister, etc. may recommend that designated operator, etc. for children with disabilities to establish an appropriate management system, in accordance with the requirements specified by Order of the Ministry of Health, Labour and Welfare, by the specified date.

２厚生労働大臣等は、前項の規定による勧告をした場合において、その勧告を受けた指定障害児事業者等が、同項の期限内にこれに従わなかつたときは、その旨を公表することができる。

(2)If the Minister of Health, Labour and Welfare, etc. has issued the recommendation under the preceding paragraph, and the designated operator, etc. for children with disabilities that has received the recommendation fails to comply with the recommendation within the period specified in the same paragraph, the Minister, etc. may make a public announcement to that effect.

３厚生労働大臣等は、第一項の規定による勧告を受けた指定障害児事業者等が、正当な理由がなくてその勧告に係る措置をとらなかつたときは、当該指定障害児事業者等に対し、期限を定めて、その勧告に係る措置をとるべきことを命ずることができる。

(3)If the designated operator, etc. for children with disabilities that has received the recommendation under paragraph (1) fails to implement measures pertaining to these recommendations without just cause, the Minister of Health, Labour and Welfare, etc. may order that designated operator, etc. for children with disabilities to implement those measures within a specified period.

４厚生労働大臣等は、前項の規定による命令をしたときは、その旨を公示しなければならない。

(4)The Minister of Health, Labour and Welfare, etc. who has issued an order under the preceding paragraph must make a public notice of the fact.

５厚生労働大臣又は指定都市若しくは中核市の長は、指定障害児通所支援事業者が第三項の規定による命令に違反したときは、厚生労働省令で定めるところにより、当該違反の内容を関係都道府県知事に通知しなければならない。

(5)If a designated operator of outpatient support services for children with disabilities violates an order under paragraph (3), the Minister of Health, Labour and Welfare or the mayor of a designated city or core city must send notice of the violation to the relevant prefectural governor in accordance with Order of the Ministry of Health, Labour and Welfare.

第二十一条の五の二十九市町村は、通所給付決定に係る障害児が、通所給付決定の有効期間内において、指定障害児通所支援事業者等（病院その他厚生労働省令で定める施設に限る。以下この款において同じ。）から医療型児童発達支援のうち治療に係るもの（以下この条において「肢体不自由児通所医療」という。）を受けたときは、当該障害児に係る通所給付決定保護者に対し、当該肢体不自由児通所医療に要した費用について、肢体不自由児通所医療費を支給する。

Article 21-5-29(1)A municipality, in the case where a child with disabilities pertaining to grant decision on outpatient benefits payments, within effective period of grant decision on outpatient benefits payments, is to receive medical services child developmental support pertaining to medical treatment, (hereinafter referred to "outpatient medical treatment for orthopedically impaired children" in this Article), from designated operators, etc. of outpatient support service for children with disabilities (limited to hospital or other facility specified in Order of Ministry of Health, Labour and Welfare; the same applies in this subsection), for recognized outpatient beneficiary custodian pertaining to the relevant children with disabilities, pay outpatient medical expenses for orthopedically impaired children.

２肢体不自由児通所医療費の額は、一月につき、肢体不自由児通所医療（食事療養を除く。）につき健康保険の療養に要する費用の額の算定方法の例により算定した額から、当該通所給付決定保護者の家計の負担能力その他の事情をしん酌して政令で定める額（当該政令で定める額が当該算定した額の百分の十に相当する額を超えるときは、当該相当する額）を控除して得た額とする。

(2)The amount of outpatient medical expenses for outpatient medical treatment for orthopedically impaired children is the amount obtained by deducting the amount specified by Cabinet Order (when ten-hundredths (10/100) of the relevant amount provided by the relevant Cabinet Order exceeds the amount provided by a Cabinet Order, the relevant amount equivalent thereto) from the amount calculated according to the example of calculation method of the amount of the expenses required for medical treatment of health insurance for outpatient medical treatment for orthopedically impaired children (excluding dietary treatment) per month by taking into account the financial capacity of the household of the relevant recognized outpatient beneficiary custodian.

３通所給付決定に係る障害児が指定障害児通所支援事業者等から肢体不自由児通所医療を受けたときは、市町村は、当該障害児に係る通所給付決定保護者が当該指定障害児通所支援事業者等に支払うべき当該肢体不自由児通所医療に要した費用について、肢体不自由児通所医療費として当該通所給付決定保護者に支給すべき額の限度において、当該通所給付決定保護者に代わり、当該指定障害児通所支援事業者等に支払うことができる。

(3)When a child with disabilities pertaining to a decision on outpatient benefits receives outpatient medical treatment for orthopedically impaired children from a designated operator, etc. of outpatient support services for children with disabilities, the municipality may pay the expenses required for relevant outpatient medical treatment for orthopedically impaired children payable by the recognized beneficiary custodian pertaining to the relevant child with disabilities to the relevant designated operator, etc. of outpatient support services for children with disabilities in lieu of the relevant recognized outpatient beneficiary custodian, to the relevant designated operator, etc. of outpatient support services, within the limit of the amount payable to the relevant recognized beneficiary custodian as the outpatient medical expenses for orthopedically impaired children.

４前項の規定による支払があつたときは、当該通所給付決定保護者に対し肢体不自由児通所医療費の支給があつたものとみなす。

(4)When a payment is made pursuant to the provisions of the preceding paragraph, the outpatient medical expenses for orthopedically impaired children for relevant recognized outpatient beneficiary custodian is deemed to have been paid.

第二十一条の五の三十第十九条の十二及び第十九条の二十の規定は指定障害児通所支援事業者等に対する肢体不自由児通所医療費の支給について、第二十一条の規定は指定障害児通所支援事業者等について、それぞれ準用する。この場合において、必要な技術的読替えは、政令で定める。

Article 21-5-30The provisions of Article 19-12 and Article 19-20 apply mutatis mutandis to payment of the outpatient medical expenses for orthopedically impaired children to the designated operator, etc. of outpatient support services, and the provisions of Article 20 to the designated operator, etc. of outpatient support services, respectively.In this case, necessary terminological replacements are prescribed by Cabinet Order.

第二十一条の五の三十一肢体不自由児通所医療費の支給は、当該障害の状態につき、健康保険法の規定による家族療養費その他の法令に基づく給付であつて政令で定めるもののうち肢体不自由児通所医療費の支給に相当するものを受けることができるときは政令で定める限度において、当該政令で定める給付以外の給付であつて国又は地方公共団体の負担において肢体不自由児通所医療費の支給に相当するものが行われたときはその限度において、行わない。

Article 21-5-31Payment of the outpatient medical expenses for orthopedically impaired children is not to be made for medical care of orthopedically impaired children to the extent provided by Cabinet Order if the child is eligible for benefits equivalent to payment of the outpatient medical expenses for orthopedically impaired children among benefits provided by Cabinet Order which are benefits for dependents' medical expenses under the Health Insurance Act or any other benefits based on Laws and Regulations in light of the condition of the relevant disabilities or to the extent covered by the benefits granted if benefits have been provided which are other than the benefits provided by the relevant Cabinet Order and which are equivalent to payment of the outpatient medical expenses for orthopedically impaired children at the expense of the national or local governments.

第二十一条の五の三十二この款に定めるもののほか、肢体不自由児通所医療費の支給及び指定障害児通所支援事業者等の肢体不自由児通所医療費の請求に関し必要な事項は、厚生労働省令で定める。

Article 21-5-32Beyond what is specified in this subsection, necessary particulars concerning payment of the outpatient medical expenses for orthopedically impaired children and claim for payment of the outpatient medical expenses for orthopedically impaired children of the designated operator, etc. of outpatient support services is specified by Ministry of Health, Labour and Welfare.

第二十一条の六市町村は、障害児通所支援又は障害者の日常生活及び社会生活を総合的に支援するための法律第五条第一項に規定する障害福祉サービス（以下「障害福祉サービス」という。）を必要とする障害児の保護者が、やむを得ない事由により障害児通所給付費若しくは特例障害児通所給付費又は同法に規定する介護給付費若しくは特例介護給付費（第五十六条の六第一項において「介護給付費等」という。）の支給を受けることが著しく困難であると認めるときは、当該障害児につき、政令で定める基準に従い、障害児通所支援若しくは障害福祉サービスを提供し、又は当該市町村以外の者に障害児通所支援若しくは障害福祉サービスの提供を委託することができる。

Article 21-6A municipality, if it is found to be extremely difficult for the custodian of a child with disabilities in need of the welfare services for persons with disabilities prescribed in Article 5, paragraph (1) of Act on the Comprehensive Support for the Daily and Life in Society of Persons with Disabilities (hereinafter referred to as " welfare services for persons with disabilities") to receive nursing care benefits or exceptional nursing care benefits prescribed in the same Act (referred to as "nursing care benefits, etc." in Article 56-6, paragraph (1)) due to any unavoidable reason, in accordance with the standards specified by a Cabinet Order, may provide outpatient support for children with disabilities or welfare services for persons with disabilities to relevant child with disabilities or entrust the provision of outpatient support for children with disabilities or welfare services for persons with disabilities to a person other than relevant municipality.

第二十一条の七障害児通所支援事業を行う者及び障害者の日常生活及び社会生活を総合的に支援するための法律第五条第一項に規定する障害福祉サービス事業を行う者は、前条の規定による委託を受けたときは、正当な理由がない限り、これを拒んではならない。

Article 21-7A person engaged in the welfare services for persons with disabilities provided in Article 5, paragraph (1) of Act on the Comprehensive Support for the Daily and Life in Society of Persons with Disabilities, if requested to accept entrustment pursuant to the provisions of the preceding Article, must not refuse it without justifiable grounds.

第二十一条の八市町村は、次条に規定する子育て支援事業に係る福祉サービスその他地域の実情に応じたきめ細かな福祉サービスが積極的に提供され、保護者が、その児童及び保護者の心身の状況、これらの者の置かれている環境その他の状況に応じて、当該児童を養育するために最も適切な支援が総合的に受けられるように、福祉サービスを提供する者又はこれに参画する者の活動の連携及び調整を図るようにすることその他の地域の実情に応じた体制の整備に努めなければならない。

Article 21-8In order that welfare services pertaining to the child care support services provided in the following Article and other carefully-crafted welfare services in line with the condition of each region can be positively provided and that each custodian can comprehensively receive the most adequate support for fostering their children in line with the mental and physical condition, environment and other conditions of relevant children and custodians, a municipal government must endeavor to facilitate liaison and coordination for activities of the persons providing or participating in welfare services, and develop other systems in line with the condition of each region.

第二十一条の九市町村は、児童の健全な育成に資するため、その区域内において、放課後児童健全育成事業、子育て短期支援事業、乳児家庭全戸訪問事業、養育支援訪問事業、地域子育て支援拠点事業、一時預かり事業、病児保育事業及び子育て援助活動支援事業並びに次に掲げる事業であつて主務省令で定めるもの（以下「子育て支援事業」という。）が着実に実施されるよう、必要な措置の実施に努めなければならない。

Article 21-9For the purpose of contributing to the sound upbringing of children, a municipality must endeavor to implement necessary measures in order that after-school child sound upbringing services and short-term child care support services, house-call services for all households with babies, house-call services to support childrearing, local childrearing support center services, temporary custody services, childcare for sick children and family support center services and the following services as specified by an order of the competent ministry (hereinafter referred to as "child care support services") can be carried out steadily within its district:

第二十一条の十市町村は、児童の健全な育成に資するため、地域の実情に応じた放課後児童健全育成事業を行うとともに、当該市町村以外の放課後児童健全育成事業を行う者との連携を図る等により、第六条の三第二項に規定する児童の放課後児童健全育成事業の利用の促進に努めなければならない。

Article 21-10For the purpose of contributing to the sound upbringing of children, a municipality must perform after-school child sound upbringing services in line with the condition of each region and endeavor to promote the utilization of after-school child sound upbringing services for the children provided in paragraph (2) of Article 6-3 by such means as carrying out coordination with persons engaged in after-school child sound upbringing services other than the relevant municipality.

第二十一条の十の二市町村は、児童の健全な育成に資するため、乳児家庭全戸訪問事業及び養育支援訪問事業を行うよう努めるとともに、乳児家庭全戸訪問事業により要支援児童等（特定妊婦を除く。）を把握したとき又は当該市町村の長が第二十六条第一項第三号の規定による送致若しくは同項第八号の規定による通知若しくは児童虐待の防止等に関する法律第八条第二項第二号の規定による送致若しくは同項第四号の規定による通知を受けたときは、養育支援訪問事業の実施その他の必要な支援を行うものとする。

Article 21-10-2(1)For the purpose of contributing to the sound upbringing of children, a municipality is to endeavor to perform house-call services for all households with babies and house-call services to support childrearing and, in the case where child, etc. requiring assistance (excluding specified expectant mothers) are found by house-call services for all households with babies or the mayor of the head of the municipality receive referral pursuant to the provisions of Article 26, paragraph (1), item (iii) or notice pursuant to the provisions of item (xiii) of the same paragraph or referral pursuant to Article 8, paragraph (2), item (ii) of Child Abuse Prevention and Treatment Act or notice pursuant to the provisions of item (iv) of the same paragraph, is to implement house-call services to support childrearing and provide other necessary support.

２市町村は、母子保健法（昭和四十年法律第百四十一号）第十条、第十一条第一項若しくは第二項（同法第十九条第二項において準用する場合を含む。）、第十七条第一項又は第十九条第一項の指導に併せて、乳児家庭全戸訪問事業を行うことができる。

(2)A municipality may perform house-call services for all households with babies beyond guidance of Article 10, Article 11, paragraph (1) or (2), Article 17, paragraph (1) or Article 19, paragraph (1) of Maternal and Child Health Act) (including application mutatis mutandis to Article 19, paragraph (2) of the same Act).

３市町村は、乳児家庭全戸訪問事業又は養育支援訪問事業の事務の全部又は一部を当該市町村以外の厚生労働省令で定める者に委託することができる。

(3)A municipality may entrust the whole or a part of the affairs of house-call services for all households with babies and house-call services to support childrearing.

４前項の規定により行われる乳児家庭全戸訪問事業又は養育支援訪問事業の事務に従事する者又は従事していた者は、その事務に関して知り得た秘密を漏らしてはならない。

(4)A person who is, or used to be, engaged in the affairs concerning house-call services for all households with babies and house-call services to support childrearing must not divulge any secret that may have come to their knowledge with regard to the relevant affairs.

第二十一条の十の三市町村は、乳児家庭全戸訪問事業又は養育支援訪問事業の実施に当たつては、母子保健法に基づく母子保健に関する事業との連携及び調和の確保に努めなければならない。

Article 21-10-3When performing house-call services for all households with babies and house-call services to support childrearing, a municipality must endeavor to secure coordination and harmonization with the project concerning maternal and child health based on Maternal and Child Health Act.

第二十一条の十の四都道府県知事は、母子保健法に基づく母子保健に関する事業又は事務の実施に際して要支援児童等と思われる者を把握したときは、これを当該者の現在地の市町村長に通知するものとする。

Article 21-10-4A prefectural governor, in the case of finding the person as deemed to be a child requiring assistance upon implementing the project or affairs concerning maternal and child health based on Maternal and Child Health Act, is to notify this to the mayor or head of a municipality of the current location of the relevant person.

第二十一条の十の五病院、診療所、児童福祉施設、学校その他児童又は妊産婦の医療、福祉又は教育に関する機関及び医師、歯科医師、保健師、助産師、看護師、児童福祉施設の職員、学校の教職員その他児童又は妊産婦の医療、福祉又は教育に関連する職務に従事する者は、要支援児童等と思われる者を把握したときは、当該者の情報をその現在地の市町村に提供するよう努めなければならない。

Article 21-10-5(1)A person engaged in organizations relevant to medical treatment, welfare or education such as a hospital, clinic, child welfare facility, school and others and the duties relevant to medical treatment of children or expectant and nursing mothers including a doctor, dentist, public health nurse, midwife, nurse, official of child welfare facility, teacher in schools and others, in the case of finding the person deemed to be a child, etc. requiring assistance, the relevant person must endeavor to provide information for the mayor or head of a municipality of the current location of the relevant person.

２刑法の秘密漏示罪の規定その他の守秘義務に関する法律の規定は、前項の規定による情報の提供をすることを妨げるものと解釈してはならない。

(2)The provisions concerning the crime of unlawful disclosure of confidential information set forth in the Penal Code and provisions in any other Act that provide for confidentiality obligations must not be construed to preclude a report .

第二十一条の十一市町村は、子育て支援事業に関し必要な情報の収集及び提供を行うとともに、保護者から求めがあつたときは、当該保護者の希望、その児童の養育の状況、当該児童に必要な支援の内容その他の事情を勘案し、当該保護者が最も適切な子育て支援事業の利用ができるよう、相談に応じ、必要な助言を行うものとする。

Article 21-11(1)A municipality is to collect and provide necessary information concerning child care support services and, upon request from a custodian, provide consultation and necessary advice to enable the relevant custodian to utilize the most adequate Child Care Support Services, by taking into consideration the relevant custodian's wishes, the state of foster care of their child the content of the support necessary for the relevant child and other circumstances.

２市町村は、前項の助言を受けた保護者から求めがあつた場合には、必要に応じて、子育て支援事業の利用についてあつせん又は調整を行うとともに、子育て支援事業を行う者に対し、当該保護者の利用の要請を行うものとする。

(2)Upon request from the custodian receiving advice set forth in the preceding paragraph, the municipal government, where necessary, is to make arrangements or carry out coordination for the utilization of Child Care Support Services and make a request for such utilization by relevant custodian to a person engaged in the Child Care Support Services

３市町村は、第一項の情報の収集及び提供、相談並びに助言並びに前項のあつせん、調整及び要請の事務を当該市町村以外の者に委託することができる。

(3)A municipality may entrust the affairs concerning the collection and provision of information and consultation and advice set forth in paragraph (1), and the arrangement, coordination and requests set forth in the preceding paragraph to a person other than relevant municipality.

４子育て支援事業を行う者は、前三項の規定により行われる情報の収集、あつせん、調整及び要請に対し、できる限り協力しなければならない。

(4)A person engaged in child care support services must cooperate in the collection of information, arrangement, coordination and requests made pursuant to the provisions of the preceding three paragraphs as much as possible.

第二十一条の十二前条第三項の規定により行われる情報の提供、相談及び助言並びにあつせん、調整及び要請の事務（次条及び第二十一条の十四第一項において「調整等の事務」という。）に従事する者又は従事していた者は、その事務に関して知り得た秘密を漏らしてはならない。

Article 21-12A person who is, or used to be, engaged in the affairs concerning the provision of information, the consultation and advice, and the arrangement, coordination and requests pursuant to the provisions of paragraph (3) of the preceding Article (referred to as "coordination and other affairs" in the following Article and Article 21-14, paragraph (1)) must not divulge any secret that may have come to their knowledge with regard to such affairs.

第二十一条の十三市町村長は、第二十一条の十一第三項の規定により行われる調整等の事務の適正な実施を確保するため必要があると認めるときは、その事務を受託した者に対し、当該事務に関し監督上必要な命令をすることができる。

Article 21-13When a mayor of a municipality finds it necessary in order to ensure adequate implementation of coordination and other affairs conducted pursuant to the provisions of Article 21-11, paragraph (3), the mayor may give orders necessary for the supervision of relevant affairs to the persons accepting the entrusted affairs.

第二十一条の十四市町村長は、第二十一条の十一第三項の規定により行われる調整等の事務の適正な実施を確保するため必要があると認めるときは、その必要な限度で、その事務を受託した者に対し、報告を求め、又は当該職員に、関係者に対し質問させ、若しくは当該事務を受託した者の事務所に立ち入り、その帳簿書類その他の物件を検査させることができる。

Article 21-14(1)When a mayor of municipality finds it necessary in order to ensure adequate implementation of coordination and other affairs conducted pursuant to the provisions of Article 21-11, paragraph (3), the mayor may, within the limit necessary therefor, request a person accepting the entrusted affairs to make a report, or make relevant municipality's official ask relevant persons questions or enter any office of the person accepting relevant entrusted affairs and inspect the books and documents and other objects.

２第十八条の十六第二項及び第三項の規定は、前項の場合について準用する。

(2)The provisions of Article 18-16, paragraphs (2) and (3) apply mutatis mutandis to the case referred to in the preceding paragraph.

第二十一条の十五国、都道府県及び市町村以外の子育て支援事業を行う者は、厚生労働省令で定めるところにより、その事業に関する事項を市町村長に届け出ることができる。

Article 21-15A person engaged in child care support services, other than the national government, prefectural governments and municipal governments, may notify the mayor of municipality of the particulars concerning their services, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

第二十一条の十六国及び地方公共団体は、子育て支援事業を行う者に対して、情報の提供、相談その他の適当な援助をするように努めなければならない。

Article 21-16The national and local governments must endeavor to provide information and give consultation and other appropriate assistance to persons engaged in child care support services

第二十一条の十七国及び都道府県は、子育て支援事業を行う者が行う福祉サービスの質の向上のための措置を援助するための研究その他保護者の児童の養育を支援し、児童の福祉を増進するために必要な調査研究の推進に努めなければならない。

Article 21-17The national government and prefectures must endeavor to encourage such studies as well as assist in measures for improvement of the quality of welfare services performed by persons engaged in child care support services, and other researches and studies necessary to support to take care of children by their custodians and promote welfare of children.

第二十四条の二都道府県は、次条第六項に規定する入所給付決定保護者（以下この条において「入所給付決定保護者」という。）が、次条第四項の規定により定められた期間内において、都道府県知事が指定する障害児入所施設（以下「指定障害児入所施設」という。）又は指定発達支援医療機関（以下「指定障害児入所施設等」と総称する。）に入所又は入院（以下「入所等」という。）の申込みを行い、当該指定障害児入所施設等から障害児入所支援（以下「指定入所支援」という。）を受けたときは、当該入所給付決定保護者に対し、当該指定入所支援に要した費用（食事の提供に要する費用、居住又は滞在に要する費用その他の日常生活に要する費用のうち厚生労働省令で定める費用及び治療に要する費用（以下「入所特定費用」という。）を除く。）について、障害児入所給付費を支給する。

Article 24-2(1)When a recognized admission beneficiary custodian provided in paragraph (6) of the following Article (referred to as a "recognized admission beneficiary custodian" hereinafter in this Article) applies for admission or institutionalization (hereinafter referred to as "admission, etc.") into an admission institution for children with disabilities (hereinafter referred to as "designated admission institution for children with disabilities") or a designated developmental support medical institution (hereinafter referred to as "designated admission institution, etc. for children with disabilities" collectively.) designated by the prefectural governor during the period of time provided pursuant to the provisions of paragraph (4) of the following Article and the custodian receives admission support for children with disabilities from relevant designated admission institution, etc. for children with disabilities (hereinafter referred to as "designated admission support"), the prefecture is to pay admission benefits for children with disabilities to relevant recognized admission beneficiary custodian with regard to expenses spent for relevant designated admission support (excluding such expenses spent for meal provision, expenses spent for residency or stay and other expenses spent for daily life provided by an Order of the Ministry of Health, Labour and Welfare, and expenses spent on medical treatment (hereinafter referred to as "specified admission expenses")).

２障害児入所給付費の額は、一月につき、第一号に掲げる額から第二号に掲げる額を控除して得た額とする。

(2)The amount of payment of admission benefits for children with disabilities is to be the amount obtained by deducting the amount listed in item (i) from the one listed in item (ii).

第二十四条の三障害児の保護者は、前条第一項の規定により障害児入所給付費の支給を受けようとするときは、厚生労働省令で定めるところにより、都道府県に申請しなければならない。

Article 24-3(1)When the custodian of a child with disabilities intends to receive admission benefits for children with disabilities pursuant to the provisions of paragraph (1) of the preceding Article, the custodian must make an application with the prefectural government, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

２都道府県は、前項の申請が行われたときは、当該申請に係る障害児の心身の状態、当該障害児の介護を行う者の状況、当該障害児の保護者の障害児入所給付費の受給の状況その他の厚生労働省令で定める事項を勘案して、障害児入所給付費の支給の要否を決定するものとする。

(2)When an application set forth in the preceding paragraph is made, the prefecture is to decide whether to pay admission benefits for children with disabilities, by taking into consideration the type and level of the dysfunction of the child with disabilities pertaining to relevant application, the state of a caretaker of relevant child with disabilities, the state of receipt of admission benefits for children with disabilities by the custodian of relevant child with disabilities, and other particulars specified by an Order of the Ministry of Health, Labour and Welfare.

３前項の規定による決定を行う場合には、児童相談所長の意見を聴かなければならない。

(3)In the case where a decision is made pursuant to the provisions of the preceding paragraph, the prefectural government must hear opinions from the director of a child guidance center.

４障害児入所給付費を支給する旨の決定（以下「入所給付決定」という。）を行う場合には、障害児入所給付費を支給する期間を定めなければならない。

(4)In the case where a decision to pay admission benefits for children with disabilities (hereinafter referred to as "decision on admission benefits payment") is made, a period for payments of admission benefits for children with disabilities must be specified.

５前項の期間は、厚生労働省令で定める期間を超えることができないものとする。

(5)A period set forth in the preceding paragraph may not exceed the period specified by an Order of the Ministry of Health, Labour and Welfare.

６都道府県は、入所給付決定をしたときは、当該入所給付決定を受けた障害児の保護者（以下「入所給付決定保護者」という。）に対し、厚生労働省令で定めるところにより、第四項の規定により定められた期間（以下「給付決定期間」という。）を記載した入所受給者証（以下「入所受給者証」という。）を交付しなければならない。

(6)When a decision on admission benefits payment is made, the prefectural government must issue a beneficiary certificate (hereinafter referred to as " admission beneficiary certificate") stating the period specified pursuant to the provisions of paragraph (4) (hereinafter referred to as "benefits payment period") to the custodian of the child with disabilities for whom relevant decision on admission benefits payments is made (hereinafter referred to as "recognized admission beneficiary custodian"), pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

７指定入所支援を受けようとする入所給付決定保護者は、厚生労働省令で定めるところにより、指定障害児入所施設等に入所受給者証を提示して当該指定入所支援を受けるものとする。ただし、緊急の場合その他やむを得ない事由のある場合については、この限りでない。

(7)A recognized admission beneficiary custodian who intends to receive designated admission support must receive relevant designated admission support by presenting their admission beneficiary certificate to the designated institution, etc. for children with disabilities, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare; provided, however, that this does not apply in the case of an emergency or any other unavoidable reason

８入所給付決定保護者が指定障害児入所施設等から指定入所支援を受けたとき（当該入所給付決定保護者が当該指定障害児入所施設等に入所受給者証を提示したときに限る。）は、都道府県は、当該入所給付決定保護者が当該指定障害児入所施設等に支払うべき当該指定入所支援に要した費用（入所特定費用を除く。）について、障害児入所給付費として当該入所給付決定保護者に支給すべき額の限度において、当該入所給付決定保護者に代わり、当該指定障害児入所施設等に支払うことができる。

(8)When a recognized admission beneficiary custodian has received designated institutional support from a designated admission institution, etc. for children with disabilities, (limited to the cases where the relevant recognized admission beneficiary custodian has presented the custodian admission beneficiary certificate to relevant designated admission institution, etc. for children with disabilities), the prefecture may pay expenses spent for the relevant designated admission support that are payable by the relevant recognized admission beneficiary custodian to the relevant designated institution, etc. for children with disabilities (excluding specified expenses), in lieu of relevant custodian, to relevant designated admission institution, etc. for children with disabilities, within the limit of the amount payable to the relevant recognized admission beneficiary custodian as the admission benefits for children with disabilities.

９前項の規定による支払があつたときは、当該入所給付決定保護者に対し障害児入所給付費の支給があつたものとみなす。

(9)When a payment is made pursuant to the provisions of the preceding paragraph, the admission benefits for children with disabilities for the referenced recognized admission beneficiary custodian is deemed to have been paid.

１０都道府県は、指定障害児入所施設等から障害児入所給付費の請求があつたときは、前条第二項第一号の厚生労働大臣が定める基準及び第二十四条の十二第二項の指定障害児入所施設等の設備及び運営に関する基準（指定入所支援の取扱いに関する部分に限る。）に照らして審査の上、支払うものとする。

(10)When a designated admission institution, etc. for children with disabilities, etc. requests admission benefits for children with disabilities, the prefecture is to pay the same after the examination in light of the standards specified by the Minister of Health, Labor and Welfare as set forth in paragraph (2), item (i) of the preceding Article and the standards on facilities and operation of the designated child with mental disabilities outpatient, etc. as set forth in Article 24-12, paragraph (2) (limited to the portions of such standards relating to handling of designated admission support).

１１都道府県は、前項の規定による審査及び支払に関する事務を連合会に委託することができる。

(11)A prefectural government may entrust the federation of national health insurance to conduct the affairs concerning examination and payments pursuant to the provisions of the preceding paragraph.

第二十四条の四入所給付決定を行つた都道府県は、次に掲げる場合には、当該入所給付決定を取り消すことができる。

Article 24-4(1)A prefectural government making a grant decision on admission benefits payment may rescind the relevant decision on outpatient benefits payment may rescind the relevant decision on admission benefits payment in any of the cases listed in the following items:

２前項の規定により入所給付決定の取消しを行つた都道府県は、厚生労働省令で定めるところにより、当該取消しに係る入所給付決定保護者に対し入所受給者証の返還を求めるものとする。

(2)A prefecture having rescinded a decision on admission benefits payment pursuant to the provisions of the preceding paragraph is to request the recognized admission beneficiary custodian pertaining to the relevant rescission to return the admission beneficiary certificate pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

第二十四条の五都道府県が、災害その他の厚生労働省令で定める特別の事情があることにより、障害児入所支援に要する費用を負担することが困難であると認めた入所給付決定保護者が受ける障害児入所給付費の支給について第二十四条の二第二項の規定を適用する場合においては、同項第二号中「額）」とあるのは、「額）の範囲内において都道府県が定める額」とする。

Article 24-5In the case where the prefectural government applies the provisions of paragraph (2) of Article 24-2 to payments of admission benefits for children with disabilities to a recognized admission beneficiary custodian since it finds difficult for the custodian to bear the expenses spent for admission support for children with disabilities due to disaster or other special circumstances specified by an Order of the Ministry of Health, Labour and Welfare, the term "amount" referred to in the same paragraph, item (ii) is replaced with "the amount specified by the prefectural government within the range of (the amount ".

第二十四条の六都道府県は、入所給付決定保護者が受けた指定入所支援に要した費用の合計額（厚生労働大臣が定める基準により算定した費用の額（その額が現に要した費用の額を超えるときは、当該現に要した額）の合計額を限度とする。）から当該費用につき支給された障害児入所給付費の合計額を控除して得た額が、著しく高額であるときは、当該入所給付決定保護者に対し、高額障害児入所給付費を支給する。

Article 24-6(1)When the amount obtained (in the case the amount actually required exceeds the amount calculated from the standard specified by Minister of Health, Labour and Welfare, the relevant amount actually required) by deducting the total amount of admission benefits for children with disabilities paid in relation to the expenses spent for designated admission support received by a recognized admission beneficiary custodian from the total amount of such expenses is extremely costly, high-cost admission benefits for children with disabilities are paid to the relevant custodian pursuant to the provisions of Cabinet Order.

２前項に定めるもののほか、高額障害児入所給付費の支給要件、支給額その他高額障害児入所給付費の支給に関し必要な事項は、指定入所支援に要する費用の負担の家計に与える影響を考慮して、政令で定める。

(2)Beyond what is prescribed in the preceding paragraph, the requirements for payments of high-cost admission benefits for children with disabilities, the amounts to be paid, and other necessary particulars concerning payments of high-cost admission benefits for children with disabilities are prescribed by a Cabinet Order by considering the impact of the burden of expenses spent for designated admission support on household finances.

第二十四条の七都道府県は、入所給付決定保護者のうち所得の状況その他の事情をしん酌して厚生労働省令で定めるものに係る障害児が、給付決定期間内において、指定障害児入所施設等に入所等をし、当該指定障害児入所施設等から指定入所支援を受けたときは、当該入所給付決定保護者に対し、当該指定障害児入所施設等における食事の提供に要した費用及び居住に要した費用について、政令で定めるところにより、特定入所障害児食費等給付費を支給する。

Article 24-7(1)When a child with disabilities pertaining to such a recognized admission beneficiary custodian that is specified by an Order of the Ministry of Health, Labour and Welfare is taken into account through the custodian's state of income and other circumstances is admitted into a designated admission institution, etc. for children with disabilities, during the benefits payment period and the children with disabilities receives designated admission support from relevant designated admission institution, etc. for children with disabilities, the prefecture is to, pursuant to the provisions of a Cabinet Order, pay benefits for meal expenses, etc. for specified institutionalized children with disabilities to relevant recognized admission beneficiary custodian with regard to the expenses spent for the provision of meals and for residence in relevant designated admission institution, etc. for children with disabilities,

２第二十四条の三第七項から第十一項までの規定は、特定入所障害児食費等給付費の支給について準用する。この場合において、必要な技術的読替えは、政令で定める。

(2)The provisions of paragraphs (7) through (11) of Article 24-3 apply mutatis mutandis to payments of benefits for meal expenses, etc. for specified institutionalized children with disabilities.In this case, necessary terminological replacements are prescribed by a Cabinet Order.

第二十四条の八この款に定めるもののほか、障害児入所給付費、高額障害児入所給付費又は特定入所障害児食費等給付費の支給及び指定障害児入所施設等の障害児入所給付費又は特定入所障害児食費等給付費の請求に関し必要な事項は、厚生労働省令で定める。

Article 24-8Beyond what is prescribed in this Subsection, necessary particulars concerning the payments of admission benefits for children with disabilities, high-cost admission benefits for children with disabilities or benefits for meal expenses, etc. for specified institutionalized children with disabilities and requests by designated admission institutions, etc. for children with disabilities for admission benefits for children with disabilities or benefits for meal expenses, etc. for specified institutionalized children with disabilities are prescribed by an Order of the Ministry of Health, Labour and Welfare.

第二十四条の九第二十四条の二第一項の指定は、厚生労働省令で定めるところにより、障害児入所施設の設置者の申請により、当該障害児入所施設の入所定員を定めて、行う。

Article 24-9(1)The designation under Article 24-2, paragraph (1) is made specified by Order of Ministry of Health, Labour and Welfare, upon application by the establisher of admission institution for children with disabilities, by specifying admission capacity of the relevant admission institution for children with disabilities.

２都道府県知事は、前項の申請があつた場合において、当該都道府県における当該申請に係る指定障害児入所施設の入所定員の総数が、第三十三条の二十二第一項の規定により当該都道府県が定める都道府県障害児福祉計画において定める当該都道府県の当該指定障害児入所施設の必要入所定員総数に既に達しているか、又は当該申請に係る施設の指定によつてこれを超えることになると認めるとき、その他の当該都道府県障害児福祉計画の達成に支障を生ずるおそれがあると認めるときは、第二十四条の二第一項の指定をしないことができる。

(2)When the application for designation under the preceding paragraph has been filed, the prefectural governor may decide not to grant an designation under Article 24-2, paragraph (1), if the total maximum capacity of designated admission institution for children with disabilities pertaining the relevant application of the relevant prefectural governments, covering for which the application was filed has already reached the total required maximum capacity for the relevant designated admission institution for children with disabilities of the relevant prefecture specified in prefectural plan for welfare of persons with disabilities pursuant to the provisions of Article 33-22, paragraph (1); where the prefectural governor finds that the establishment of designated admission institution for children with disabilities for which the application was filed would result in the authorized number of residents in excess of such maximum capacity; or in any other cases where the prefectural governor finds that the establishment thereof may prejudice the attainment of the prefectural plan for welfare of persons with disabilities.

３第二十一条の五の十五第三項（第七号を除く。）及び第四項の規定は、第二十四条の二第一項の指定障害児入所施設の指定について準用する。この場合において、必要な技術的読替えは、政令で定める。

(3)The provisions of Article 21-5-15, paragraph (3) (excluding item (vii)) apply to a designation of designated admission institution for children with disabilities of Article 24-2, paragraph (1).In this case, necessary terminological replacements are prescribed by a Cabinet Order.

第二十四条の十第二十四条の二第一項の指定は、六年ごとにその更新を受けなければ、その期間の経過によつて、その効力を失う。

Article 24-10(1)The designation set forth in paragraph (1) of Article 24-2 must cease to be effective after a lapse of the term then in force, unless the designation is renewed every six years.

２前項の更新の申請があつた場合において、同項の期間（以下この条において「指定の有効期間」という。）の満了の日までにその申請に対する処分がされないときは、従前の指定は、指定の有効期間の満了後もその処分がされるまでの間は、なおその効力を有する。

(2)In the case where a renewal set forth in the preceding paragraph is applied, when no disposition is implemented for the application by the expiration date of the period set forth in the same paragraph (referred to as a "valid period for designation" hereinafter in this Article), the designation before the renewal is to remain in force until the disposition is implemented, even after the expiration of the valid period for designation.

３前項の場合において、指定の更新がされたときは、その指定の有効期間は、従前の指定の有効期間の満了の日の翌日から起算するものとする。

(3)When the designation is renewed in the case referred to in the preceding paragraph, the valid period for designation as renewed is to start from the day following the expiration date of the valid period for designation before the renewal.

４前条の規定は、第一項の指定の更新について準用する。この場合において、必要な技術的読替えは、政令で定める。

(4)The provisions of the preceding Article apply mutatis mutandis to renewal of designation set forth in paragraph (1).In this case, necessary terminological replacements are prescribed by a Cabinet Order.

第二十四条の十一指定障害児入所施設等の設置者は、障害児が自立した日常生活又は社会生活を営むことができるよう、障害児及びその保護者の意思をできる限り尊重するとともに、行政機関、教育機関その他の関係機関との緊密な連携を図りつつ、障害児入所支援を当該障害児の意向、適性、障害の特性その他の事情に応じ、常に障害児及びその保護者の立場に立つて効果的に行うように努めなければならない。

Article 24-11(1)In order to enable a child with disabilities to lead a self-reliant daily or life in society according to their inherent abilities and aptitudes, the establisher of a designated admission institution, etc. for children with disabilities, must facilitate close coordination with administrative organs, educational institutions and other relevant bodies, and endeavor to effectively implement institutional support for children with disabilities according to the intention, aptitudes, characteristics of dysfunctions and other circumstances of relevant child with disabilities.

２指定障害児入所施設等の設置者は、その提供する障害児入所支援の質の評価を行うことその他の措置を講ずることにより、障害児入所支援の質の向上に努めなければならない。

(2)The establisher of a designated admission institution, etc. for children with disabilities must endeavor to improve the quality of its admission support for children with disabilities, by carrying out assessment of the quality of its own institutional support for children with disabilities and by taking other measures.

３指定障害児入所施設等の設置者は、障害児の人格を尊重するとともに、この法律又はこの法律に基づく命令を遵守し、障害児及びその保護者のため忠実にその職務を遂行しなければならない。

(3)The establisher of a designated admission institution, etc. for children with disabilities must respect the character of each child with disabilities, comply with this Act or orders pursuant to this Act, and faithfully perform their own duties for children with disabilities and their custodians.

第二十四条の十二指定障害児入所施設等の設置者は、都道府県の条例で定める基準に従い、指定入所支援に従事する従業者を有しなければならない。

Article 24-12(1)The establisher of a designated admission institution, etc. for children with disabilities must have employees engaged in designated admission support in accordance with the standards specified by an Order of the Ministry of Health, Labour and Welfare.

２指定障害児入所施設等の設置者は、都道府県の条例で定める指定障害児入所施設等の設備及び運営に関する基準に従い、指定入所支援を提供しなければならない。

(2)The establisher of a designated admission institution, etc. for children with disabilities must provide designated admission support in accordance with the standards on facilities and operation of designated admission institutions for children with disabilities specified by an Order of the Ministry of Health, Labour and Welfare.

３都道府県が前二項の条例を定めるに当たつては、次に掲げる事項については厚生労働省令で定める基準に従い定めるものとし、その他の事項については厚生労働省令で定める基準を参酌するものとする。

(3)In specifying the provisions of the preceding item (ii), in accordance with the standards specified by Order of Ministry of Health, Labour and Welfare concerning the particulars listed as follows and is to prescribe other particulars by taking into consideration Order of the Ministry of Health, Labour and Welfare.

４第一項及び第二項の都道府県の条例で定める基準は、知的障害のある児童、盲児（強度の弱視児を含む。）、ろうあ児（強度の難聴児を含む。）、肢体不自由のある児童、重症心身障害児その他の指定障害児入所施設等に入所等をする障害児についてそれぞれの障害の特性に応じた適切な支援が確保されるものでなければならない。

(4)The standards specified by the ordinances of the prefectures of paragraph (1) and (2) must ensure appropriate support in accordance with the characteristics of respective disabilities relating to mentally disabled children, blind children (including severely amblyopic children), deaf children (including severely cloth-eared children), children with severe intellectual and physical disabilities and other children with disabilities who admit into designated admission institution, etc. for children with disabilities.

５指定障害児入所施設の設置者は、第二十四条の十四の規定による指定の辞退をするときは、同条に規定する予告期間の開始日の前日に当該指定入所支援を受けていた者であつて、当該指定の辞退の日以後においても引き続き当該指定入所支援に相当するサービスの提供を希望する者に対し、必要な障害児入所支援が継続的に提供されるよう、他の指定障害児入所施設等の設置者その他関係者との連絡調整その他の便宜の提供を行わなければならない。

(5)When the an establisher of designated admission institution for children with disabilities intends to decline the designation pursuant to the provisions of Article 24-14, for the person who received the relevant designated admission support and desires to continue to be provided with the services corresponding to the relevant designated admission support for children with disabilities even after the date of the relevant declination of the designation, in order to continuously provide necessary designated admission support for children with disabilities, the relevant establisher must carry out liaison and coordination with other designated admission institution for children with disabilities and persons concerned and provide other benefits.

第二十四条の十三指定障害児入所施設の設置者は、第二十四条の二第一項の指定に係る入所定員を増加しようとするときは、厚生労働省令で定めるところにより、同項の指定の変更を申請することができる。

Article 24-13(1)When the establisher of designated admission institution for children with disabilities intends to increase the admission capacity pertaining to the designation of Article 24-2, paragraph (1), the establisher may make an application for alternation of the designation of the same paragraph pursuant to the ordinance of Ministry of Health, Labour and Welfare.

２第二十四条の九第二項及び第三項の規定は、前項の指定の変更の申請があつた場合について準用する。この場合において、必要な技術的読替えは、政令で定める。

(2)The provisions of Article 24-9, paragraphs (2) and (3) apply mutatis mutandis to the case where there is alternation of designation.In this case, necessary terminological replacements are prescribed by Cabinet Order.

３指定障害児入所施設の設置者は、設置者の住所その他の厚生労働省令で定める事項に変更があつたときは、厚生労働省令で定めるところにより、十日以内に、その旨を都道府県知事に届け出なければならない。

(3)When there is any change in their address or any other particulars specified by an Order of the Ministry of Health, Labour and Welfare, the establisher of a designated admission institution, etc. for children with disabilities, must notify the prefectural governor to that effect within 10 days pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

第二十四条の十四指定障害児入所施設は、三月以上の予告期間を設けて、その指定を辞退することができる。

Article 24-14A designated admission institution for children with disabilities may decline its designation with not less than three months period of advance notice.

第二十四条の十四の二第二十一条の五の二十一の規定は、指定障害児入所施設の設置者による第二十四条の十二第五項に規定する便宜の提供について準用する。この場合において、第二十一条の五の二十一第一項中「都道府県知事又は市町村長」とあるのは、「都道府県知事」と読み替えるものとする。

Article 24-14-2The provisions of Article 21-5-21 apply mutatis mutandis to provision of benefits by the establisher of Designated Admission Institution set forth in Articles 24-12, paragraph (5) In this case, the phrase "the prefectural governor or the mayor of municipality" is replaced with "the prefectural governor".

第二十四条の十五都道府県知事は、必要があると認めるときは、指定障害児入所施設等の設置者若しくは当該指定障害児入所施設等の長その他の従業者（以下この項において「指定施設設置者等」という。）である者若しくは指定施設設置者等であつた者に対し、報告若しくは帳簿書類その他の物件の提出若しくは提示を命じ、指定施設設置者等である者若しくは指定施設設置者等であつた者に対し出頭を求め、又は当該職員に、関係者に対し質問させ、若しくは当該指定障害児入所施設等、当該指定障害児入所施設等の設置者の事務所その他当該指定障害児入所施設等の運営に関係のある場所に立ち入り、その設備若しくは帳簿書類その他の物件を検査させることができる。

Article 24-15(1)When a prefectural governor finds it necessary, they may order a person who is, or used to be, the establisher or director or any other employee of a designated admission institution, etc. for children with disabilities, (hereinafter referred to as "designated institution establisher, etc.") to make a report or submit or present books and documents and other objects, request the appearance of a person who is, or used to be, a designated admission institution, etc. for children with disabilities, or may make the relevant prefecture's official ask relevant persons questions or enter any office of the relevant designated admission institution, etc. for children with disabilities, the other places related to operation of relevant designated admission institution, etc. for children with disabilities, and inspect books and documents and other objects.

２第十九条の十六第二項の規定は前項の規定による質問又は検査について、同条第三項の規定は前項の規定による権限について準用する。

(2)The provisions of Article 19-16, paragraph (2) apply mutatis mutandis to the questioning or inspection pursuant to the provisions of the preceding paragraph, and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority pursuant to the provisions of the preceding paragraph.

第二十四条の十六都道府県知事は、指定障害児入所施設等の設置者が、次の各号（指定発達支援医療機関の設置者にあつては、第三号を除く。以下この項において同じ。）に掲げる場合に該当すると認めるときは、当該指定障害児入所施設等の設置者に対し、期限を定めて、当該各号に定める措置をとるべきことを勧告することができる。

Article 24-16(1)When the establisher of a designated admission institution, etc. for children with disabilities, (in the case of designated developmental support medical institution, excluding item (iii); the same applies hereinafter) is found to fall under any of the following items, the prefectural governor may order the establisher of the relevant designated admission institution, etc. for children with disabilities, to take the measure pertaining to the recommendation by a set deadline:

２都道府県知事は、前項の規定による勧告をした場合において、その勧告を受けた指定障害児入所施設等の設置者が、同項の期限内にこれに従わなかつたときは、その旨を公表することができる。

(2)In the case where a recommendation is made pursuant to the provisions of the preceding paragraph, when the establisher of the designated admission institution , etc. for children with disabilities, receiving such recommendation fails to comply with the same by the due date set forth in the same paragraph, the prefectural governor may make public to that effect.

３都道府県知事は、第一項の規定による勧告を受けた指定障害児入所施設等の設置者が、正当な理由がなくてその勧告に係る措置をとらなかつたときは、当該指定障害児入所施設等の設置者に対し、期限を定めて、その勧告に係る措置をとるべきことを命ずることができる。

(3)When the establisher of a designated admission institution, etc. for children with disabilities, receiving a recommendation pursuant to the provisions of paragraph (1) fails to take a measure pertaining to the recommendation without justifiable grounds, the prefectural governor may order the establisher of the relevant designated admission institution, etc. for children with disabilities, to take the measures pertaining to the recommendation by a due date to be specified.

４都道府県知事は、前項の規定による命令をしたときは、その旨を公示しなければならない。

(4)When an order is provided pursuant to the provisions of the preceding paragraph, the prefectural governor must give public notice to that effect.

第二十四条の十七都道府県知事は、次の各号のいずれかに該当する場合においては、当該指定障害児入所施設に係る第二十四条の二第一項の指定を取り消し、又は期間を定めてその指定の全部若しくは一部の効力を停止することができる。

Article 24-17In any of the cases set forth in the following items, the prefectural governor may rescind the designation set forth in Article 24-2, paragraph (1) pertaining to the relevant designated admission institution, etc. for children with disabilities, or suspend the validity of the designation, in whole or in part, for a period of time to be specified:

第二十四条の十八都道府県知事は、次に掲げる場合には、その旨を公示しなければならない。

Article 24-18A prefectural governor must give public notice in any of the cases listed in the following items:

第二十四条の十九都道府県は、指定障害児入所施設等に関し必要な情報の提供を行うとともに、その利用に関し相談に応じ、及び助言を行わなければならない。

Article 24-19(1)A prefectural government must provide necessary information concerning designated admission institution, etc. for children with disabilities, and provide consultations and give advice with regard to the utilization thereof.

２都道府県は、障害児又は当該障害児の保護者から求めがあつたときは、指定障害児入所施設等の利用についてあつせん又は調整を行うとともに、必要に応じて、指定障害児入所施設等の設置者に対し、当該障害児の利用についての要請を行うものとする。

(2)Upon request from a child with disabilities or their custodian, the prefectural government is to make arrangements or coordinate for the use of a designated admission institution, etc. for children with disabilities and, where needed, make a request for the utilization by the relevant child with disabilities to the establisher of a designated admission institution, etc. for children with disabilities.

３指定障害児入所施設等の設置者は、前項のあつせん、調整及び要請に対し、できる限り協力しなければならない。

(3)The establisher of a designated admission institution, etc. for children with disabilities must cooperate in the arrangement, coordination and requests set forth in the preceding paragraph as much as possible.

第二十四条の十九の二第二節第三款の規定（中核市の長に係る部分を除く。）は、指定障害児入所施設等の設置者について準用する。この場合において、必要な技術的読替えは、政令で定める。

Article 24-19-2The provisions of Section 2 Subsection 3 (excluding the part pertaining to the mayor of core city) apply mutatis mutandis to the establisher of a designated admission institution, etc. for children with disabilities.In this case, the necessary technical replacement is provided by Cabinet Order.

第二十四条の二十都道府県は、入所給付決定に係る障害児が、給付決定期間内において、指定障害児入所施設等（病院その他厚生労働省令で定める施設に限る。以下この条、次条及び第二十四条の二十三において同じ。）から障害児入所支援のうち治療に係るもの（以下この条において「障害児入所医療」という。）を受けたときは、厚生労働省令で定めるところにより、当該障害児に係る入所給付決定保護者に対し、当該障害児入所医療に要した費用について、障害児入所医療費を支給する。

Article 24-20(1)When a child with disabilities pertaining to a decision on admission benefits payment receives the institutional support for children with disabilities pertaining to therapy (hereinafter referred to as "admission medical care for children with disabilities") from a designated admission institution, etc. for children with disabilities (limited to such hospitals and other facilities as specified by an Order of the Ministry of Health, Labour and Welfare; the same applies hereinafter in this Article, the following Article and Article 24-23) during the benefits payment period, the prefectural government, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, is to pay admission medical expenses for children with disabilities to the recognized admission beneficiary custodian pertaining to the relevant child with disabilities with regard to the expenses spent for the relevant institutional medical care for children with disabilities; and

２障害児入所医療費の額は、一月につき、次に掲げる額の合算額とする。

(2)The amount of admission medical expenses for children with disabilities are the total amount of the amounts listed in the following items per month:

３入所給付決定に係る障害児が指定障害児入所施設等から障害児入所医療を受けたときは、都道府県は、当該障害児に係る入所給付決定保護者が当該指定障害児入所施設等に支払うべき当該障害児入所医療に要した費用について、障害児入所医療費として当該入所給付決定保護者に支給すべき額の限度において、当該入所給付決定保護者に代わり、当該指定障害児入所施設等に支払うことができる。

(3)When a child with disabilities pertaining to a decision on admission benefits payment receives admission medical care for children with disabilities from a designated admission institution, etc. for children with disabilities, the prefectural government may pay such expenses spent for relevant institutional medical care for children with disabilities payable by the recognized beneficiary custodian pertaining to the relevant child with disabilities to the relevant designated institution for children with disabilities, etc., in lieu of the relevant recognized beneficiary custodian, to the relevant designated institution for children with disabilities, etc., within the limit of the amount payable to the relevant recognized admission beneficiary custodian as the institutional medical expenses for children with disabilities.

４前項の規定による支払があつたときは、当該入所給付決定保護者に対し障害児入所医療費の支給があつたものとみなす。

(4)When a payment is made pursuant to the provisions of the preceding paragraph, the institutional medical expenses for children with disabilities for relevant recognized admission beneficiary custodian is deemed to have been paid.

第二十四条の二十一第十九条の十二及び第十九条の二十の規定は指定障害児入所施設等に対する障害児入所医療費の支給について、第二十一条の規定は指定障害児入所施設等について、それぞれ準用する。この場合において、必要な技術的読替えは、政令で定める。

Article 24-21The provisions of Article 19-12 and Article 19-20 are for the payment of medical expenses for children with disabilities to a designated admission institution, etc. for children with disabilities, and the provisions of Article 21 for a designated institution, etc. for children with disabilities apply mutatis mutandis; in this case, necessary terminological replacements are prescribed by a Cabinet Order.

第二十四条の二十二障害児入所医療費の支給は、当該障害の状態につき、健康保険法の規定による家族療養費その他の法令に基づく給付であつて政令で定めるもののうち障害児入所医療費の支給に相当するものを受けることができるときは政令で定める限度において、当該政令で定める給付以外の給付であつて国又は地方公共団体の負担において障害児入所医療費の支給に相当するものが行われたときはその限度において、行わない。

Article 24-22A payment of admission medical expenses for children with disabilities is not be made within the limits equivalent to the amount that a recipient can receive according to the state of the referenced dysfunction as prescribed in the subsequent sentence. When the recipient can receive dependent medical treatment expenses pursuant to the Health Insurance Act or other benefits pursuant to relevant laws and regulations and such expenses or benefits are specified by Cabinet Order and fall under the payment of admission medical expenses for children with disabilities, the limit specified by a Cabinet Order applies as the limit referred to in the preceding sentence, and when any benefit other than those specified by relevant Cabinet Order that falls under the payment of admission medical expenses for children with disabilities is paid and borne by the national government or local government, the amount so paid applies as the limit referred to in the preceding sentence.

第二十四条の二十三この款に定めるもののほか、障害児入所医療費の支給及び指定障害児入所施設等の障害児入所医療費の請求に関し必要な事項は、厚生労働省令で定める。

Article 24-23Beyond what is prescribed in this Subsection, necessary particulars concerning the payments of admission medical expenses for children with disabilities and the requests by designated admission institutions for children with disabilities, etc. for admission medical expenses for children with disabilities are prescribed by an Order of the Ministry of Health, Labour and Welfare.

第二十四条の二十四都道府県は、第二十四条の二第一項、第二十四条の六第一項、第二十四条の七第一項又は第二十四条の二十第一項の規定にかかわらず、厚生労働省令で定める指定障害児入所施設等に入所等をした障害児（以下この項において「入所者」という。）について、引き続き指定入所支援を受けなければその福祉を損なうおそれがあると認めるときは、当該入所者が満十八歳に達した後においても、当該入所者からの申請により、当該入所者が満二十歳に達するまで、厚生労働省令で定めるところにより、引き続き第五十条第六号の三に規定する障害児入所給付費等（次項において「障害児入所給付費等」という。）を支給することができる。ただし、当該入所者が障害者の日常生活及び社会生活を総合的に支援するための法律第五条第六項に規定する療養介護その他の支援を受けることができる場合は、この限りでない。

Article 24-24(1)For the time being, with regard to a child with disabilities under admission, etc. in any of the designated admission institution, etc. for children with disabilities specified by an Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "admittee" in this paragraph), when a prefectural government finds that welfare of the admittee is likely to be impaired unless the designated admission support for the admittee is continued, the prefectural government, notwithstanding the provisions of Article 24-2, paragraph (1), Article 24-6, paragraph (1), Article 24-7, paragraph (1) or Article 24-20, paragraph (1), may continue to pay or provide admission benefits, etc. for children with disabilities (hereinafterreferred to as "admission benefits for children with disabilities") prescribed for in the provisions of Article 50, item (vi)-3 to the relevant admittee based on their application, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, until the relevant admittee becomes able to adapt themselves to their social surroundings, even after the admittee attains the age of 18, until the relevant admittee attains the age of 20 ; provided, however, that this does not apply to the case where relevant admittee can receive the treatment and care services provided in Article 5, paragraph (6) of Act on the Comprehensive Support for the Daily and Life in Society of Persons with Disabilities or other support.

２前項の規定により障害児入所給付費等を支給することができることとされた者については、その者を障害児又は障害児の保護者とみなして、第二十四条の二から第二十四条の七まで、第二十四条の十九及び第二十四条の二十から第二十四条の二十二までの規定を適用する。この場合において、必要な技術的読替えその他これらの規定の適用に関し必要な事項は、政令で定める。

(2)With regard to a person who is eligible for admission benefits, etc. for children with disabilities pursuant to the provisions of the preceding two paragraphs, the person is deemed to be a child with disabilities or the custodian of a child with disabilities and the provisions of Articles 24-2 through 24-7 and Articles 24-19 through 24-22 apply.In this case, necessary terminological replacements are prescribed by Cabinet Order.

３第一項の場合においては、都道府県知事は、児童相談所長の意見を聴かなければならない。

(3)In the case referred to in paragraph (1), the prefectural governor must hear opinions from the director of a child guidance center.

第二十四条の二十五障害児相談支援給付費及び特例障害児相談支援給付費の支給は、障害児相談支援に関して次条及び第二十四条の二十七の規定により支給する給付とする。

Article 24-25The payments of consultation benefits for children with disabilities and consultation benefits for specified children with disabilities are the benefits provided pursuant to the next Article and Article 21-5-4 concerning consultation support for children with disabilities.

第二十四条の二十六市町村は、次の各号に掲げる者（以下この条及び次条第一項において「障害児相談支援対象保護者」という。）に対し、当該各号に定める場合の区分に応じ、当該各号に規定する障害児相談支援に要した費用について、障害児相談支援給付費を支給する。

Article 24-26(1)A municipality is to pay consultation support benefits for children with disabilities to a person listed in the following each item (hereinafter referred to as "custodian eligible for consultation support benefits for children with disabilities"), the expenses required for consultation support for children with disabilities specified in the relevant each item, for the categories of cases set forth respectively in the relevant item.

２障害児相談支援給付費の額は、指定障害児支援利用援助又は指定継続障害児支援利用援助（以下「指定障害児相談支援」という。）に通常要する費用につき、厚生労働大臣が定める基準により算定した費用の額（その額が現に当該指定障害児相談支援に要した費用の額を超えるときは、当該現に指定障害児相談支援に要した費用の額）とする。

(2)The amount of consultation support benefits for children with disabilities is the amount of expenses calculated, in accordance with the standards specified by the Minister of Health, Labor and Welfare, with regard to expenses generally spent for the designated use of support for children with disabilities or designated continuous use of support for children with disabilities (hereinafter referred to as "designated consultation support for children with disabilities) (the full amount of such expenses actually spent for the relevant designated consultation support when the amount so calculated exceeds the relevant actual amount of the expenses required for consultation support for children with disabilities).

３障害児相談支援対象保護者が指定障害児相談支援事業者から指定障害児相談支援を受けたときは、市町村は、当該障害児相談支援対象保護者が当該指定障害児相談支援事業者に支払うべき当該指定障害児相談支援に要した費用について、障害児相談支援給付費として当該障害児相談支援対象保護者に対し支給すべき額の限度において、当該障害児相談支援対象保護者に代わり、当該指定障害児相談支援事業者に支払うことができる。

(3)When a custodian eligible for consultation support benefits for children with disabilities has received designated consultation support from a designated operator, etc. of consultation support service for children with disabilities, the municipality may pay expenses spent for the relevant designated consultation support payable by the relevant custodian eligible for consultation support benefits for children with disabilities to the relevant designated operator of consultation support services for children with disabilities on behalf of relevant custodian, within the limit of the amount payable to the relevant custodian eligible for consultation support benefits for children with disabilities as this payment constituting as consultation support benefits for children with disabilities.

４前項の規定による支払があつたときは、障害児相談支援対象保護者に対し障害児相談支援給付費の支給があつたものとみなす。

(4)When a payment is made pursuant to the provisions of the preceding paragraph, consultation support benefits for children with disabilities for the relevant custodian eligible for consultation support benefits for children with disabilities is deemed to have been paid.

５市町村は、指定障害児相談支援事業者から障害児相談支援給付費の請求があつたときは、第二項の厚生労働大臣が定める基準及び第二十四条の三十一第二項の厚生労働省令で定める指定障害児相談支援の事業の運営に関する基準（指定障害児相談支援の取扱いに関する部分に限る。）に照らして審査の上、支払うものとする。

(5)When a designated operator of consultation support services for children with disabilities requests consultation support benefits for children with disabilities, the municipality is to pay the same after the examination in light of the standards specified by the Minister of Health, Labor and Welfare as set forth in paragraph (2) and the standards on facilities and operation of designated consultation support services for children with disabilities as set forth in Article 24-31, paragraph (2) (limited to the portions of such standards relating to handling of designated consultation support for children with disabilities).

６市町村は、前項の規定による審査及び支払に関する事務を連合会に委託することができる。

(6)A municipality may entrust the federation of national health insurance to conduct the affairs concerning examination and payments pursuant to the provisions of the preceding paragraph.

７前各項に定めるもののほか、障害児相談支援給付費の支給及び指定障害児相談支援事業者の障害児相談支援給付費の請求に関し必要な事項は、厚生労働省令で定める。

(7)Beyond what is prescribed in the preceding paragraphs, necessary particulars concerning the payments of consultation support benefits for children with disabilities and requests by designated operator of consultation support services for children with disabilities for consultation support benefits for children with disabilities are prescribed by an Order of the Ministry of Health, Labour and Welfare.

第二十四条の二十七市町村は、障害児相談支援対象保護者が、指定障害児相談支援以外の障害児相談支援（第二十四条の三十一第一項の厚生労働省令で定める基準及び同条第二項の厚生労働省令で定める指定障害児相談支援の事業の運営に関する基準に定める事項のうち厚生労働省令で定めるものを満たすと認められる事業を行う事業所により行われるものに限る。以下この条において「基準該当障害児相談支援」という。）を受けた場合において、必要があると認めるときは、厚生労働省令で定めるところにより、基準該当障害児相談支援に要した費用について、特例障害児相談支援給付費を支給することができる。

Article 24-27(1)When a municipality finds necessary, in the case where custodian eligible for consultation support benefits for children with disabilities receive consultation support for children with disabilities other than designated consultation support for children with disabilities (limited to the services applicable to the particulars prescribed by Ministry of Health, Labour and Welfare which are prescribed in the standards concerning operation of the services of designated consultation support for children with disabilities prescribed by Order of Ministry of Health, Labour and Welfare of Article 24-31, paragraph (1) and the ones prescribed by Order of Ministry of Health, Labour and Welfare of paragraph (2) of the same Article, which refers to as "appropriate consultation support for children with disabilities), the municipality may pay specified consultation support benefits for children with disabilities, for the expenses required for appropriate consultation support for children with disabilities.

２特例障害児相談支援給付費の額は、当該基準該当障害児相談支援について前条第二項の厚生労働大臣が定める基準により算定した費用の額（その額が現に当該基準該当障害児相談支援に要した費用の額を超えるときは、当該現に基準該当障害児相談支援に要した費用の額）を基準として、市町村が定める。

(2)The amount of specified consultation support benefits for children with disabilities is determined by the municipality by using the amount of expenses calculated from the standards prescribed by Minister of Health, Labour and Welfare of paragraph (2) of the preceding Article (in the case such amount actually exceeds the amount required for the relevant appropriate consultation support for children with disabilities, the relevant amount actually required for the relevant appropriate consultation support for children with disabilities).

３前二項に定めるもののほか、特例障害児相談支援給付費の支給に関し必要な事項は、厚生労働省令で定める。

(3)Beyond what is prescribed in the preceding two paragraphs, necessary particulars concerning the payments of specified consultation support benefits for children with disabilities are prescribed by an Order of the Ministry of Health, Labour and Welfare.

第二十四条の二十八第二十四条の二十六第一項第一号の指定障害児相談支援事業者の指定は、厚生労働省令で定めるところにより、総合的に障害者の日常生活及び社会生活を総合的に支援するための法律第五条第十八項に規定する相談支援を行う者として厚生労働省令で定める基準に該当する者の申請により、障害児相談支援事業を行う事業所（以下「障害児相談支援事業所」という。）ごとに行う。

Article 24-28(1)The designation of designated operator of consultation support services for children with disabilities set forth in Article 24-26, paragraph (1), item (i) is made for each institution that practice consultation support services for children with disabilities (hereinafter referred to as "consultation support services office for children with disabilities") as the one who practice consultation services specified in Article 5, paragraph (18) of Act on the Comprehensive Support for the Daily and Life in Society of Persons with Disabilities pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

２第二十一条の五の十五第三項（第四号、第十一号及び第十四号を除く。）の規定は、第二十四条の二十六第一項第一号の指定障害児相談支援事業者の指定について準用する。この場合において、第二十一条の五の十五第三項第一号中「都道府県の条例で定める者」とあるのは、「法人」と読み替えるほか、必要な技術的読替えは、政令で定める。

(2)The provisions of Article 21-5-15, paragraph (3) (excluding items (iv) and (xiv)) apply to designation of designated operator of consultation support services for children with disabilities of Article 24-26, paragraph (1), item (i).In this case, the term "a person specified by prefectural ordinance" in Article 21-5-15, paragraph (3), item (i) is replaced with "a corporation". Beyond this, necessary terminological replacements are prescribed by a Cabinet Order.

第二十四条の二十九第二十四条の二十六第一項第一号の指定は、六年ごとにその更新を受けなければ、その期間の経過によつて、その効力を失う。

Article 24-29(1)The designation of Article 24-26, paragraph (1), item (i) ceases to be effective after a lapse of the term then in force, unless the designation is renewed every 6 years.

２前項の更新の申請があつた場合において、同項の期間（以下この条において「指定の有効期間」という。）の満了の日までにその申請に対する処分がされないときは、従前の指定は、指定の有効期間の満了後もその処分がされるまでの間は、なおその効力を有する。

(2)In the case where a renewal set forth in the preceding paragraph is applied, when no disposition is implemented for the application by the expiration date of the period set forth in the same paragraph (referred to as a "effective period for designation" hereinafter in this Article), the designation before the renewal remains in force until the disposition is implemented, even after the expiration of the effective period for designation.

３前項の場合において、指定の更新がされたときは、その指定の有効期間は、従前の指定の有効期間の満了の日の翌日から起算するものとする。

(3)When the designation is renewed in the case referred to in the preceding paragraph, the effective period for designation as renewed starts from the day following the expiration date of the effective period for designation before the renewal.

４前条の規定は、第一項の指定の更新について準用する。この場合において、必要な技術的読替えは、政令で定める。

(4)The provisions of the preceding Article apply mutatis mutandis to renewal of designation set forth in paragraph (1).In this case, necessary terminological replacements are prescribed by Cabinet Order.

第二十四条の三十指定障害児相談支援事業者は、障害児が自立した日常生活又は社会生活を営むことができるよう、障害児及びその保護者の意思をできる限り尊重するとともに、行政機関、教育機関その他の関係機関との緊密な連携を図りつつ、障害児相談支援を当該障害児の意向、適性、障害の特性その他の事情に応じ、常に障害児及びその保護者の立場に立つて効果的に行うように努めなければならない。

Article 24-30(1)In order to enable a child with disabilities to lead a self-reliant daily or social life according to their inherent abilities and aptitudes, designated operator of consultation support services for children with disabilities must facilitate close coordination with administrative organs, educational institutions and other relevant bodies, and endeavor to effectively implement institutional support for children with disabilities according to the intention, aptitudes, characteristics of dysfunctions and other circumstances of the relevant child with disabilities constantly from the standpoint of children with disabilities and their custodians.

２指定障害児相談支援事業者は、その提供する障害児相談支援の質の評価を行うことその他の措置を講ずることにより、障害児相談支援の質の向上に努めなければならない。

(2)The designated operator of consultation support services for children with disabilities must endeavor to improve the quality of its consultation support for children with disabilities by carrying out assessment of the quality of its own institutional support for children with disabilities and by taking other measures.

３指定障害児相談支援事業者は、障害児の人格を尊重するとともに、この法律又はこの法律に基づく命令を遵守し、障害児及びその保護者のため忠実にその職務を遂行しなければならない。

(3)The designated operator of consultation support services for children with disabilities must respect the character of each child with disabilities, comply with this Act or orders pursuant to this Act, and faithfully perform their own duties for children with disabilities and their custodians.

第二十四条の三十一指定障害児相談支援事業者は、当該指定に係る障害児相談支援事業所ごとに、厚生労働省令で定める基準に従い、当該指定障害児相談支援に従事する従業者を有しなければならない。

Article 24-31(1)The designated operator of consultation support service for children with disabilities must have employees engaged in the relevant designated consultation support for children with disabilities in accordance with the standards specified by an Order of the Ministry of Health, Labour and Welfare for each designated operator of consultation support service office for children with disabilities pertaining to the relevant designation.

２指定障害児相談支援事業者は、厚生労働省令で定める指定障害児相談支援の事業の運営に関する基準に従い、指定障害児相談支援を提供しなければならない。

(2)The designated operator of consultation support service for children with disabilities must provide designated consultation support for children with disabilities in accordance with the standards on facilities and operation of designated consultation support services for children with disabilities specified by an Order of the Ministry of Health, Labour and Welfare.

３指定障害児相談支援事業者は、次条第二項の規定による事業の廃止又は休止の届出をしたときは、当該届出の日前一月以内に当該指定障害児相談支援を受けていた者であつて、当該事業の廃止又は休止の日以後においても引き続き当該指定障害児相談支援に相当する支援の提供を希望する者に対し、必要な障害児相談支援が継続的に提供されるよう、他の指定障害児相談支援事業者その他関係者との連絡調整その他の便宜の提供を行わなければならない。

(3)When a designated operator of consultation support services for children with disabilities makes a notification of abolition or suspension of operation pursuant to the provisions of paragraph (2) of the following Article, the designated operator of consultation support services for children with disabilities must conduct liaison and coordination with other designated operator of consultation support services for children with disabilities and relevant persons, and provide other benefits to ensure that the a person, who has received the designated consultation support for children with disabilities within one month before the date of the notification and wishes to continue receive the provision of support equivalent to the designated consultation support for children with disabilities even after the date of abolition or the suspension of the operation, continues to receive the necessary designated consultation support for children with disabilities.

第二十四条の三十二指定障害児相談支援事業者は、当該指定に係る障害児相談支援事業所の名称及び所在地その他厚生労働省令で定める事項に変更があつたとき、又は休止した当該指定障害児相談支援の事業を再開したときは、厚生労働省令で定めるところにより、十日以内に、その旨を市町村長に届け出なければならない。

Article 24-32(1)When the name and location of the consultation support services office for children with disabilities pertaining to the designation and other particulars specified by Order of the Ministry of Health, Labour and Welfare are changed, or when the suspended operation of designated consultation support for children with disabilities is resumed, the designated operator of consultation support services for children with disabilities must notify the mayor of municipality to that effect within ten days, in accordance with the provisions of Order of the Ministry of Health, Labour and Welfare.

２指定障害児相談支援事業者は、当該指定障害児相談支援の事業を廃止し、又は休止しようとするときは、厚生労働省令で定めるところにより、その廃止又は休止の日の一月前までに、その旨を市町村長に届け出なければならない。

(2)When a designated operator of consultation support services for children with disabilities intends to abolish or suspend the operation of designated consultation support for children with disabilities, the designated operator of consultation support services for children with disabilities must notify the mayor of municipality to that effect one month before the date of its abolition or suspension, in accordance with Order of the Ministry of Health, Labour and Welfare.

第二十四条の三十三市町村長は、指定障害児相談支援事業者による第二十四条の三十一第三項に規定する便宜の提供が円滑に行われるため必要があると認めるときは、当該指定障害児相談支援事業者その他の関係者相互間の連絡調整又は当該指定障害児相談支援事業者その他の関係者に対する助言その他の援助を行うことができる。

Article 24-33When a mayor of municipality finds it necessary to smoothly carry out the provision of the benefits prescribed in Article 24-31, paragraph (3) by a designated operator of consultation support services for children with disabilities, the mayor of municipality may conduct liaison and coordination between the designated operator of consultation support services for children with disabilities and other relevant persons, or provide advice and other assistance to the designated operator of consultation support services for children with disabilities and other relevant persons.

第二十四条の三十四市町村長は、必要があると認めるときは、指定障害児相談支援事業者若しくは指定障害児相談支援事業者であつた者若しくは当該指定に係る障害児相談支援事業所の従業者であつた者（以下この項において「指定障害児相談支援事業者であつた者等」という。）に対し、報告若しくは帳簿書類その他の物件の提出若しくは提示を命じ、指定障害児相談支援事業者若しくは当該指定に係る障害児相談支援事業所の従業者若しくは指定障害児相談支援事業者であつた者等に対し出頭を求め、又は当該職員に、関係者に対し質問させ、若しくは当該指定障害児相談支援事業者の当該指定に係る障害児相談支援事業所、事務所その他指定障害児相談支援の事業に関係のある場所に立ち入り、その設備若しくは帳簿書類その他の物件を検査させることができる。

Article 24-34(1)When it is found necessary, a mayor of municipality may order a person who is, or used to be, the designated operator of consultation support services for children with disabilities or the employee of the consultation services support office for children with disabilities pertaining to the designation (hereinafter referred to as the "person, etc. who used to be the designated operator of consultation support services for children with disabilities" in this paragraph) to make a report or submit or present books and documents and other objects, request the appearance of the designated operator of consultation support services for children with disabilities or the employee of the designated operator of consultation support services for children with disabilities or the person, etc. who was the employee of the designated consultation support services office for children with disabilities, or may make the official ask relevant persons questions or enter any consulting support services office for children with disabilities pertaining to the designation of the designated operator of consultation support services for children with disabilities and other places related to the operation of consultation support for children with disabilities and inspect equipment, books and documents and other objects.

２第十九条の十六第二項の規定は前項の規定による質問又は検査について、同条第三項の規定は前項の規定による権限について準用する。

(2)The provisions of Article 19-16, paragraph (2) apply mutatis mutandis to the question or the inspection under the provisions of the preceding paragraph, and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority under the provisions of the preceding paragraph.

第二十四条の三十五市町村長は、指定障害児相談支援事業者が、次の各号に掲げる場合に該当すると認めるときは、当該指定障害児相談支援事業者に対し、期限を定めて、当該各号に定める措置をとるべきことを勧告することができる。

Article 24-35(1)When a mayor of a municipality finds that a designated operator of consultation support services for children with disabilities falls under any of the following items, the mayor of a municipality may recommend the designated operator of consultation support services for children with disabilities to take measures prescribed in each item, by a due date to be specified.

２市町村長は、前項の規定による勧告をした場合において、その勧告を受けた指定障害児相談支援事業者が、同項の期限内にこれに従わなかつたときは、その旨を公表することができる。

(2)In the case where a recommendation is made pursuant to the provisions of the preceding paragraph, when the designated operator of consultation support services for children with disabilities receiving the recommendation fails to comply with the same by a set deadline, in the same paragraph, the mayor of a municipality may make public to that effect.

３市町村長は、第一項の規定による勧告を受けた指定障害児相談支援事業者が、正当な理由がなくてその勧告に係る措置をとらなかつたときは、当該指定障害児相談支援事業者に対し、期限を定めて、その勧告に係る措置をとるべきことを命ずることができる。

(3)When the designated operator of consultation support services for children with disabilities receiving a recommendation pursuant to the provisions of paragraph (1) fails to take a measure pertaining to the recommendation without justifiable ground, the mayor of a municipality may order the designated operator of consultation support services for children with disabilities to take the measure pertaining to the recommendation by a set deadline.

４市町村長は、前項の規定による命令をしたときは、その旨を公示しなければならない。

(4)When an order is provided pursuant to the provisions of the preceding paragraph, the mayor of a municipality must give a public notice to that effect.

第二十四条の三十六市町村長は、次の各号のいずれかに該当する場合においては、当該指定障害児相談支援事業者に係る第二十四条の二十六第一項第一号の指定を取り消し、又は期間を定めてその指定の全部若しくは一部の効力を停止することができる。

Article 24-36In any of the cases set forth in the following items, a mayor of municipality may rescind the designation set forth in Article 24-26, paragraph (1), item (i) pertaining to the relevant designated operator of consultation support services for children with disabilities or suspend the validity of the designation, in whole or in part, for a period of time to be specified:

第二十四条の三十七市町村長は、次に掲げる場合には、その旨を公示しなければならない。

Article 24-37A mayor of municipality must give public notice in any of the cases listed in the following items:

第二十四条の三十八指定障害児相談支援事業者は、第二十四条の三十第三項に規定する義務の履行が確保されるよう、厚生労働省令で定める基準に従い、業務管理体制を整備しなければならない。

Article 24-38(1)The designated operator of consultation support services for children with disabilities must establish a management system in accordance with Order of the Ministry of Health, Labour and Welfare to ensure that the duties prescribed in Article 24-30, paragraph (3) are carried out.

２指定障害児相談支援事業者は、次の各号に掲げる区分に応じ、当該各号に定める者に対し、厚生労働省令で定めるところにより、業務管理体制の整備に関する事項を届け出なければならない。

(2)The designated operator of consultation support services for children with disabilities, according to their category set forth in the relevant following items, must give notification of particulars pertaining to the establishment of a management system to the relevant person specified in that item, in accordance with the Order of the Ministry of Health, Labour and Welfare.

３前項の規定により届出をした指定障害児相談支援事業者は、その届け出た事項に変更があつたときは、厚生労働省令で定めるところにより、遅滞なく、その旨を当該届出をした厚生労働大臣、都道府県知事又は市町村長（以下この款において「厚生労働大臣等」という。）に届け出なければならない。

(3)A designated operator of consultation support services for children with disabilities who has made the notification pursuant to the provisions of the preceding paragraph, if there is a change in the notified particulars, must notify the Minister of Health, Labour and Welfare, the prefectural governor or the mayor of municipality (hereinafter referred to as the "Minister of Health, Labour and Welfare, etc." in this Subsection) to that effect without delay, in accordance with Order of the Ministry of Health, Labour and Welfare.

４第二項の規定による届出をした指定障害児相談支援事業者は、同項各号に掲げる区分の変更により、同項の規定により当該届出をした厚生労働大臣等以外の厚生労働大臣等に届出を行うときは、厚生労働省令で定めるところにより、その旨を当該届出をした厚生労働大臣等にも届け出なければならない。

(4)When a designated operator of consultation support services for children with disabilities who has made a notification pursuant to the provisions of paragraph (2) makes a notification to the Minister of Health, Labour and Welfare, etc. other than the Minister of Health, Labor and Welfare, etc. pursuant to the provisions of the same paragraph due to changes in the categories listed in each item of the same paragraph, the designated operator of consultation support services for children with disabilities must also notify the Minister of Health, Labour and Welfare, etc. for whom the notification was made to that effect, in accordance with Order of the Ministry of Health, Labour and Welfare.

５厚生労働大臣等は、前三項の規定による届出が適正になされるよう、相互に密接な連携を図るものとする。

(5)The Minister of Health, Labor and Welfare, etc. is to work closely with each other so that the notification pursuant to the provisions of the preceding three paragraphs will be made properly

第二十四条の三十九前条第二項の規定による届出を受けた厚生労働大臣等は、当該届出をした指定障害児相談支援事業者（同条第四項の規定による届出を受けた厚生労働大臣等にあつては、同項の規定による届出をした指定障害児相談支援事業者を除く。）における同条第一項の規定による業務管理体制の整備に関して必要があると認めるときは、当該指定障害児相談支援事業者に対し、報告若しくは帳簿書類その他の物件の提出若しくは提示を命じ、当該指定障害児相談支援事業者若しくは当該指定障害児相談支援事業者の従業者に対し出頭を求め、又は当該職員に、関係者に対し質問させ、若しくは当該指定障害児相談支援事業者の当該指定に係る障害児相談支援事業所、事務所その他の指定障害児相談支援の提供に関係のある場所に立ち入り、その設備若しくは帳簿書類その他の物件を検査させることができる。

Article 24-39(1)When a Minister of Health, Labour and Welfare, etc. who received the notification pursuant to the provisions of paragraph (2) of the preceding Article finds it necessary for the development of management system pursuant to the provisions of paragraph (1) of the same Article in the designated operator of consultation support services for children with disabilities who made the notification (with regard to the Minister of Health, Labor and Welfare, etc. who received the notification pursuant to the provisions of paragraph (4) of the same Article, the designated operator of consultation support services for children with disabilities who made the notification pursuant to the same paragraph is excluded), the Minister of Health, Labour and Welfare, etc. may order the designated operator of consultation support services for children with disabilities to make a report or submit or present books and documents and other objects, request the appearance of the designated operator of consultation support services for children with disabilities or the employee of the designated operator of consultation support services for children with disabilities, or may make the official ask relevant persons questions or enter any establishment or consultation support services office for children with disabilities pertaining to the designation of the designated operator of consultation support services for children with disabilities and other places related to the provision of consultation support for children with disabilities and inspect equipment, books and documents and other objects.

２厚生労働大臣が前項の権限を行うときは当該指定障害児相談支援事業者に係る指定を行つた市町村長（以下この項及び次条第五項において「関係市町村長」という。）と、都道府県知事が前項の権限を行うときは関係市町村長と密接な連携の下に行うものとする。

(2)When the Minister of Health, Labour and Welfare exercise the authority set forth in the preceding paragraph, it is conducted in close cooperation with the mayor of municipality who has made the designation pertaining to the designated operator of consultation support services for children with disabilities (hereinafter referred to as the "relevant municipal mayor" in this paragraph and paragraph (5) of the following Article), and when the prefectural governor exercises the authority set forth in the preceding paragraph, it is conducted in close cooperation with the relevant municipal mayor.

３市町村長は、その行つた又はその行おうとする指定に係る指定障害児相談支援事業者における前条第一項の規定による業務管理体制の整備に関して必要があると認めるときは、厚生労働大臣又は都道府県知事に対し、第一項の権限を行うよう求めることができる。

(3)When a mayor of municipality finds it necessary for the development of a management system pursuant to the provisions of paragraph (1) of the preceding Article in the designated operator of consultation support services for children with disabilities pertaining to the designation made or will be made by the mayor of municipality, the mayor of municipality may request the Minister of Health, Labour and Welfare or the prefectural governor to exercise the authority set forth in paragraph (1).

４厚生労働大臣又は都道府県知事は、前項の規定による市町村長の求めに応じて第一項の権限を行つたときは、厚生労働省令で定めるところにより、その結果を当該権限を行うよう求めた市町村長に通知しなければならない。

(4)When a Minister of Health, Labour and Welfare or a prefectural governor exercised the authority set forth in paragraph (1) in response to a request from a mayor of municipality pursuant to the provisions of the preceding paragraph, the Minister of Health, Labour and Welfare or the prefectural governor must notify the mayor of municipality who requested the exercise of the authority about the result, in accordance with Order of Ministry of Health, Labour and Welfare

５第十九条の十六第二項の規定は第一項の規定による質問又は検査について、同条第三項の規定は第一項の規定による権限について準用する。

(5)The provisions of Article 19-16, paragraph (2) apply mutatis mutandis to the question or the inspection under the provisions of paragraph (1), and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the exercise of the authority under the provisions of paragraph (1).

第二十四条の四十第二十四条の三十八第二項の規定による届出を受けた厚生労働大臣等は、当該届出をした指定障害児相談支援事業者（同条第四項の規定による届出を受けた厚生労働大臣等にあつては、同項の規定による届出をした指定障害児相談支援事業者を除く。）が、同条第一項の厚生労働省令で定める基準に従つて適正な業務管理体制の整備をしていないと認めるときは、当該指定障害児相談支援事業者に対し、期限を定めて、当該厚生労働省令で定める基準に従つて適正な業務管理体制を整備すべきことを勧告することができる。

Article 24-40(1)When a Minister of Health, Labour and Welfare, etc. who received the notification pursuant to the provisions of Article 24-38, paragraph (2) finds that a designated operator of consultation support services for children with disabilities who made the notification (for the Minister of Health, Labor and Welfare, etc. who received the notification pursuant to the provisions of paragraph (4) of the same Article, the designated operator of consultation support services for children with disabilities who made the notification pursuant to the same paragraph is excluded) has not developed an appropriate operational control system in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare set forth in paragraph (1) of the same Article, the Minister of Health, Labour and Welfare, etc. may recommend the designated operator of consultation support services for children with disabilities to develop an appropriate operation control system by a set deadline, in accordance with Order of the Ministry of Health, Labour and Welfare.

２厚生労働大臣等は、前項の規定による勧告をした場合において、その勧告を受けた指定障害児相談支援事業者が、同項の期限内にこれに従わなかつたときは、その旨を公表することができる。

(2)Minister of Health, Labour and Welfare, etc. in a case of providing recommendation pursuant to the provisions of the preceding paragraph, may provide public notice of the fact that the relevant designated operator of consultation support services for children with disabilities receiving such recommendation fails to comply with the same by the due date set forth in the same paragraph.

３厚生労働大臣等は、第一項の規定による勧告を受けた指定障害児相談支援事業者が、正当な理由がなくてその勧告に係る措置をとらなかつたときは、当該指定障害児相談支援事業者に対し、期限を定めて、その勧告に係る措置をとるべきことを命ずることができる。

(3)When a designated operator of consultation support services for children with disabilities receiving a recommendation pursuant to the provisions of paragraph (1) fails to take a measure pertaining to the recommendation without justifiable ground, the Minister of Health, Labour and Welfare, etc. may order the designated operator of consultation support services for children with disabilities to take the measure pertaining to the recommendation by a due date to be specified.

４厚生労働大臣等は、前項の規定による命令をしたときは、その旨を公示しなければならない。

(4)The Minister of Health, Labour and Welfare, etc. who has issued an order under the preceding paragraph must make a public notice of the fact.

５厚生労働大臣又は都道府県知事は、指定障害児相談支援事業者が第三項の規定による命令に違反したときは、厚生労働省令で定めるところにより、当該違反の内容を関係市町村長に通知しなければならない。

(5)If a designated operator of consultation support services for children with disabilities violates an order under paragraph (3), the Minister of Health, Labour and Welfare or the prefectural governor must send notice of the violation to the relevant municipal mayor in accordance with Order of the Ministry of Health, Labour and Welfare.